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DUUiv — — f ii ■/ i nitS— 



AMERICAN 

FAMILY PHYSICIAN; 

DETAILING 

Important Means of preserving Health, from infancy 

to old age: 

THE OFFICES WOMEN SHOULD PERFORM TQ EACH OTHER AT 
BIRTHS, AND THE DISEASES PECULIAR TO THE SEX: 

WITH THOSE OF 

CHILDREN AND OF ADULTS. 

WITH AN 



CONTAINING 



AtNING 

Hints respecting the Treatment of Domestic Animals, 

AND 

THE BEST MEANS OF PRESERVING FISH AND MEAT. 



/ — 

BY TH EWELL, M. D., of Virginia. 

■ 'Member of the Philadelphia Medical Society; formerly Surgeon of the JVavy 

Yards at New York and City of M ashing ton; and author of the -works 

entitled Discourses on Chi mintry, Letters to Ladies, and Attempt 

to improve the Theory and Practice of Medicine^ &c. 



GO ON WITH TOUR LABOURS. IK ATTEMPTING TO INSTRUCT OTHERS, WE 

instruct ourselves. — [Letter from Dr. Rush. 



GEORGETOWN, D. C. 
PUBLISHED BY JAMES THOMAS. 



1824. ' 



James C. Dunn, Printer. 







DISTRICT OF COLUMBIA, to wit: 

Be it remembered, That, on the 27th day of November, in the 
year of our Lord one thousand eight hundred and twenty-four, and 
of the Independence of the United States of America the forty-ninth, 
James Thomas, of the said District, hath deposited in the office of the 
Clerk of the District Court for the District of Columbia, the title of a 
Book, the right whereof he claims as proprietor, in the words follow- 
ing - — to wit: 

"American Family Physician; detailing- important Means of pre- 
serving" Health, from infancy to old age: the offices women should 
perform to each other at births, and the diseases peculiar to the sex: 
with those of children and of adults. With an Appendix, containing* 
Hints respecting- the Treatment of Domestic Animals, and the best 
means of preserving* Fish and Meat. By Thomas Ewell, M. D., of 
Virginia. — Member of the Philadelphia Medical Society; formerly 
Surgeon of the Navy Yards at New York and City of Washington; 
and author of the works entitled Discourses on Chemistry, Letters to 
Ladies, and Attempt to improve the Theory and Practice of Medicine, 
&c. 'Go on with your labours. In attempting to instruct others, we 
instruct ourselves.' — [Letter from Dr. Rush.'* 

In conformity to the act of the Congress of the United States, enti- 
tled " \n act for the encouragement of learning, by securing the co- 
pies of Maps, Charts, and Books, to the authors and proprietors of 
such copies, during the times therein mentioned" — and, also, to the 
act, entitled "An act supplementary to an act, entitled 'An act for 
the- encouragement of learning, by securing the copies of Maps, 
Charts, and Books, to the authors and proprietors of such copies, 
during th-e times therein mentioned,' and extending the benefits 
thereof to the arts of designing, engraving, and etching historical and 
* other prints." 

jpoe^o&gg I s testimony whereof, I have hereunto set my hand, and affix- 
V L ' s * £ ed the public seal of my office, the day and year aforesaid. 

EDM. I. LEE, Clerk of the District Court 

for the District of Columbia. 






As the persons for whom this work is designed, may 
not be acquainted with Dr. EwelPs professional cha- 
racter; the publisher deems it proper, to insert the fol- 
lowing from the Medical Repository, of New York; 
conducted by the celebrated Dr. Samuel S. Mitchell, 
and that no less eminent Physician, the late Dr. Miller. 
In announcing Dr. EwelFs intended publication on 
Chemistry, the Editors add — 

"This gentleman has distinguished himself by some ingeni- 
ous and learned performances. The zeal and enterprise he dis- 
plays in scientific pursuits, give a pleasing earnest of what his 
country may hereafter expect from the application of his ta- 
lents to professional objects, or any other by which public good 
may be advanced. — [_New York Medical Repository , Vol. 9, p. 
?34, published in 1806. 

"Dr. Thomas Ewell appears before the public at an early 
period of life: and therefore does not claim for his perfor- 
mance that maturitv of execution, which a more deliberate ex- 
nxise of his powe s would undoubtedly confer. He is impel- 
'd by an ardour of enthusiasm, natural at his age, which every 
K eral mind will cherish and commend. After doing so much 
so well, in so short a time, and under the pressure of other 
pursuits, it would be unjust to require perfection. We warm- 
ly recommend his work to the perusal and patronage of the 
public. We consider him as one of those on whom the hopes 
and confidence of his country may safely rest. And from the 
talents, enterprise, and research displayed in this publication, 
we look forward to his future exertions and rising powers, as 
a source of usefulness, distinction, and lasting fame." — [Jfo'cf, 
Vol. 10, p. 236, published in 1807. 



1 



TO THE READER. 

THE unavoidable hurry with which some parts of 
this work were put through the press, and the occa- 
sional absence of the author, have caused some errors: 
among which, the reader is particularly requested to 
correct the following with his pen, before perusal: — 

Page 40, in the 7th line from the bottom, for "scratching on" 
read scorching one, and substitute is for be. And in the 13th 
line, for "body" read lady. 

Page 134, 12th line from bottom, for "vinegar or squills" read 
vinegar of squills. 

Page 411, 16th line from bottom, for "opium" read sugar of 
lead. 






V. 



>* 



Page, 

Dedication, ------ 9 

Preface, - - - -- - li 

ADDRESS I. 

PRESERVATION OF HEALTH. 

Directions for preserving the health of infants, - 21 

Washing and dressing navel, - - - . 22 

Time of applying to the breast, - - - 23 

Rules for nourishing children, - 24 

Raising without the breast, - - - 25 

First moving of children, - 26 

Bathing daily in warm water, - - 27 

Rocking children, - -. . - - 28 

Place for sleeping in cold weather, - - ib. 

Keeping bowels open, - 30 

Proper air and clothing, - - - - 32 

Proper diet after weaning, - 32 

Time for weaning and teething, - - - 33 

Cutting gums, - - - - - 34 

Health after infancy, ----- 37 

The atmosphere, - - - . - ib. 

Cold air, ---_.. 33 

Warming the body, - - - - 41 

Hot and dry air, ----- 43 

Damp air, ------ 44 

Composition of air; fixed air; vital air, - .45 

Inflammable air; infectious air, - 48 

Purification of air, - - - - - 49 

Proper plan for hospitals, - - * 50 

Of the sun and guarding against its rays, - - 52 

Of diet — important directions, - - - 59 



Vlll 

Page. 
Drinks, ------ 64 

Cleanliness, - 65 

General and local bathing, - - - - 66 

Air bath, - - - ... - 68 

Cold and hot bath, - - - - 69 

Purification of mouth and teeth, - - - 72 

Best tooth powder, - - - - -73 

Removal of decayed teeth, ... '74 

Evacuations from the bowels, - - - - 75 

Do. of urine, ----- 77 

Perspiration, - ' *- - - - - 78 

Exercise and rest, - - - - 79 

The passions— anger, - - - - - 81 

Fear, grief, and love, - - - 82 

Joy and religion, - - - - 83 

Intemperance, ----- 85 

To guard against certain accidents, - - - 88 

Recapitulation, ----- 89 

ADDRESS II.— MEDICAL PART. 

Dedication to Dr. Joseph Hartshorne, - - 95 

Principles of life, ----- 97 

Structme of the body, - - - - 98 

Principles on which it is made, - 99 
Circulation of blood, ----- 104 

Do". through the liver, - - - 10 5 
Respiration, ------ ib. 

Principles of disease — and on which cures are effected, 105 

Means of curing — or materia medica, - - 109 

Qualifications of attendants on the sick, - - 1 10 

Mode of administering glysters, - - - 112 

Mode of cupping, - - - - ib. 

Do. dressing blisters, - - - 113 

Do. applying bandages, - - - ib. 

Do. bleeding, - - - - 114 

Do. warm bath, - - - - 116 

Precaution to observe in fever, - - 117 



XX 



To make poultices, - - - - - 117 

Classification of medicines, - - - .118 

Stimulants, or medicines to excite general action, - 119 

Stomachics, cordials, and carminatives, - - 120 

Anti-spasmodics, or medicines to remove spasm, - 121 
Anodynes, or medicines to allay pain and produce sleep, ib. 

Tonics, or strengthening medicines, - - 122 

Astringents, or medicines to stop discharges, • 125 

Emetics, or medicines to excite vomiting, - 126 

Purgative and laxative medicines, - - - 127 
Diuretics, or medicines to increase the discharge of urine, 129 

Sudorifics, or medicines to excite sweating, - 130 

Anti-acids — medicines to counteract acidity, - 132 

Anti-lithics — to destroy stones in the kidneys, - ib. 

Vermifuge, or medicines to destroy worms, - - 133 
Expectorants, or medicines to promote the discharge of 

mucus from the lungs, - - - - 134 

Emmenagogues, or medicines to promote the flow of the 

menses, - ? - - ib. 

Demulcents, or medicines to sheath irritated parts, 135 

Alteratives, or medicines to alter the general state of the 

system, ------ ib. 

Local and external stimulants, - -136 

Ointments, ------ 137 

Caustics, - - - - - - 138 

List of medicines for family use, - 140 

ADDRESS III. 

To Ladies, respecting themselves, - -. - 141 

Description of parts concerned in birth, - - 143 

Bones of the child's head, ... 146 

Introduction of catheter, to draw off urine, - 148 

Falling down of the womb, - - - - 152 

Falling backwards of do., -' - - ib. 

Inversion of do., - - - 153 

Dropsy near do., - 154 

Menses, or monthly courses, - - - - ib. 

Excessive menstruation, - - - - 157 



Obstructed and painful menstruation, - 

Period of cessation of menses, 

Fluor albus, or whites, - - - 

Hysteric fits, - 

History of pregnancy, - 

Cautions during do., - 

Diseases of do., 

Sickness at stomach, - ■ 

Heart burn, ------ 

Colic, ------ 

Swelled legs, - 

Cramp, ._---- 

Flooding, ------ 

Abortion, ------ 

Barrenness, - - 

Of Labour, ------ 

Duties of attendants, - 

Of Touching, 

Birth of the Child, - - - 

After Birth, ------ 

Questions and answers on the subject, 

Brief rules from Dr. Merriman, - 

Cautions to the attending Midwife, 

Twins, 

Breech part presenting, - 

Knees and Feet, - 

Unnatural presentations, - - - - 

Brief recapitulation from Dr. Merriman, 

Difficult labour from the mother, - - - 

Presentation of after-birth, - - - 

Convulsions during labour, - 

Lessening the pains of labour, 

ADDRESS IV. 
MANAGEMENT OF WOMEN AFTER LABOUR. 

Diseases ensuing, and diseases of children, 

Diet after delivery, during confinement, 

during giving milk, - - - - 



Page. 
158 
160 
162 
164 
167 
172 
174 
ib. 
175 
ib. 
ib. 
176 
ib. 
182 
186 
188 
192 
193 
195 
196 
197 
200 
202 
204 
206 
207 
208 
211 
213 
220 
ib. 
221 



223 
229 
230 



I 

Page. 

Diseases of lying-in women, - 232 

Faintings and chills, - . - - ib. 

After pains, - - - - - - 233 

Irregularities of the lochia, or after discharges, - ib. 

Local swellings of the parts, - 234 

Inflammation of the breasts, - 235 

Sore nipples, - - - - - 237 

Milk fever, ------ 238 

Puerperal do. - - - - - 2-39 

Miliary or eruptive do. - 240 

Swelled leg, - - - - -\ - 242 

Mania or madness after pregnancy, - - 244 

diseases of children, - - - 245 

Suspension of life, ----- 246 

The black or livid colour of infants, - - _ 247 

Colds and Snuffles, - - ■ - - - • ib. 

Eruptions of the skin, - - - - - 248 

Sore eyes, --_-._ ib # 

Swellings and excoriations, - - - - 249 

Wind upon the stomach and bowels, - - 250 

A sickness, with or without throwing up, - - 252 

Thrush, or sore mouth, - - - - 254 

Yellowness of the skin, ----- 256 

Milk in the child's breast, - ib. 

Looseness of the bowels, - 257 

Falling of the fundament, ib. 

Of Cholic, - - - - - 258 

Of Convulsions, - - - _ .. - 259 

Fever of children, ----- 263 

Sore head, called reef or fellon, - - - 269 

Scald head, ------ 270 

Measles, - - - - ..,'.. - - ib. 

Worms, - - - - - - - 274 

Summer complaint, or cholera infantum, - - 276 

Hooping cough, ----- 278 

The croup, --..-„ ib. 



Xll 

Page, 
ADDRESS V. 

TREATMENT OF DISEASES REQUIRING IMMEDIATE ATTENTION. 

Fever, ... - - - - 281 

Causes of fever, - 286 

Epidemics or diseases generally prevailing, - - 288 

Ague and fever, ..... ib. 

Bilious or remittent fever, .... 292 

Yellow fever, - -- - - - 293 

Typhus, nervous, or, vulgarly, putrid fever, - - 294 

J^ever of intoxication, - - - - 295 

Fainting fits, ----.- 298 

Apoplectic fits, - 299 
Palsy, ------- 300 

Epileptic fits, - - - - - 301 

St. Vitus Dance, - - - - 302 

Apparent death, and means of recovery, - - ib. 

Cramp in the stomach from drinking cold water, - 306 

Poisons, ------ 308 

Bites of mad dogs, snakes, Sec. - 309 

Scalds and burns, - - - - - 310 

Involuntary discharges of blood, ■- - 314 

Bleeding of the nose, - ib. 

Spitting of blood, - - - - 316 

Vomiting of blood, ----- 317 

Voiding blood with urine, - - - - ib. 

Vomiting and purging, called cholera morbus, - 3f8 

Dysentery or flux, - - - - - 319 

Continued^ lax, or looseness of the bowels, - - 321 

Common colic, - . - - - - 323 

Dry bellyach, ----- 325 

Affections about the fundament, - _ - 326 

Piles, '- ib. 

Warts, boils, and fistulas, ... - 328 

Excoriations, - . - - - - 329 

Inflammatory sore throat or quinsey, - - - 330 

Mumps, ------ 332 

Putrid sore throat, - - . . 334 

Scarlet fever, - - - - S*« 



Xlll 



Affections of the ear, . • - 

Tooth-ach, - 

Indigestion, - 

Sprains, - 

Bruises and bruised wounds, 

Punctured wounds, - 

Wounds from cuts, - 

Wounds of the joint, 

Wounds of the nerves, tendons, and veins, 

Whitlow, . - - 

Warts and corns, -, 

Inverted toe nail, . - 

Bodies lodged in the throat, 

Frost bitten parts, 

Chilblains, - - - 

Fractures, - 

Fracture of the lower jaw, 



Do. 


ribs, 


Do, „ 


arm, 


Do. 


fore arm, 


Do. „ 


thigh, 


Do. 


knee pan, 


Do. 


leg, 


Do. „ 


collar bone. 


Dislocations, 


. 


Dislocation of the lower jaw, 


Do. 


„ collar bone, 


Do. 


„ shoulder joint, 


Do. 


„ fore arm, 


Small Pox, 


- 


Cow do., 


- 


Chicken do., 


- 



Page. 

337 

338 

340 

342 

344 

345 

346 

351 

352 

353 

354 . 

355 

ib. 
356 
357 
358 
361 
362 

ib. 
363 
364 
365 
366 
367 
368 
369 
370 

ib. 
371 
372 
375 
376 



ADDRESS VI.— REMAINING DISEASES. 



Inflammation, - 
Erysipelous, or St. Anthony's fire, 
Salivation and its diseases, 
Venereal disease. 



379 
382 

OOi> 

£->0 g 



XIV 

Page* 
Chancres, ---...- 385 

Buboes, ----._ 386 

Treatment of the constitution, - 387 

Clap or Gonorrhaea, - - - - ib. 

Asthma, • - - - - - - 390 

Rheumatism, ------ 393 

Gout, ------ 397 

Influenza, ------ 400 

Cold and Catarrh, - - - - - 401 

Continued common cough, - 403 

Consumption, ----- 404 

Inflammation of the brain, - - - 417 

Pleurisy, bastard pleurisy, &c, - - - 418 

Inflammation of the heart, - 420 

stomach, - - - 421 

intestines, - - - - 422 

liver, - - - - ib. 

spleen, - - "- - 42S 

kidneys, - - - 427 

bladder, - - , - - 428 

Difficulty in making water — stranguary, - - 429 

Suppression of urine, - ' - - 430 

Inability to retain urine, - - - - 431 

Sweet and excessive urination, called diabetes, - 432 

Dropsies, - - 434 

Dropsy of the brain, called water in the head, - - 435 

Madness, or derangement of mind, - - 437 

Nightmare, - - - - - - 440 

Kings evil, - - - - - - 441 

Rickets, ------ 444 

Scurvy, ------ 445 

Jaundice, , - - - - - - 447 

Gravel and stone, ----- 448 

Tetanus cramp, or lock-jaw, - 449 

Sore legs, - - . . . 45i 
Sore eyes, ------ 453 

Scirrhus and cancer, - 454 

Ruptures, *■„"'« - - . - 457 



Do. 


» 


Do. 


» 


Do. 


» 


Do. 


5) 


Do. 


)> 


Do. 


i» 



XV 

Page, 

Itch, ------ 458 

Ring worm, - - - ... 459 

Blotched face, - ib. 

Falling of the palate, ----- 460 

Swelling from air in the belly, - - - ib. 

Tumours, * - - - - - ib. 

Leprosy, - - - - - - 461 

Disease of the hip joint, - - - - 462 

White swelling, - - * - - 463 

Hiccough, fc - • - - ib. 

Stunning blows on the head, - ib. 

Cold feet, - - - - - 464 

Plaited hair, ( Plica fialanica,) ib. 

Dirt eating. ■ - - - - ib. 



*ir/ 



CONTENTS OF THE APPENDIX. 

Page. 

Hints respecting the treatment of Domestic Animals, 465 

Of the air, - - - - - 466 

Proper place for keeping, - 467 

Shelter from the sun, ----- 468 

The food, ------ 469 

Fattening hogs, ------ 470 

Diseases of horses, - - - - - 471 

How to bleed, cupp, blister, purge, and sweat, - - 472 
Particular diseases. Fever, with or without local affections 

in the lungs or bowels, - 473 

Cough; Flux, and Founder, - - - ib. 

Over eating, and distention of belly, - - 474 

Worms; Hide Bound; Lampas; Surfeit, - - ib. 

Strains, - - - - - 475 

Inflammation of the weathers, called Fistula, - - ib. 

Sinking of the shoulder joint; Inflamed Eyes; Wind Galls, ib. 

Wounds; Sores; Pool Evil; Grease or Scratches, - 476 

Straining and difficulty in making water, - - 477 

Swelling from the heart, called Anticar, - - ib. 

Glanders, - , - - - - - 480 

Strangles, and Colts Distemper, - - - ib. 

PRESERVATION OF MEAT AND FISH, - - ib. 

Freezing meat, - - - - - 478 

Mode of preserving meat without salt, - 479 

Portable soup, ----- 480 



/X 



DEDICATION. 

To Hobert Oliver, Esquire, of Baltimore. 

Dear Sir : 

While reading the celebrated Essays of 

the Philosopher Hume, I readily admitted the truth of 
his doctrine, that the merchant was the most important 
character on earth ; supplying the wants of one nation 
with the superfluities of another ; carrying the articles 
useless in one hemisphere for the necessities and enjoy- 
ments of the other. A view of your conduct in the mer- 
cantile world proves the truth of this position ; and I 
could have the concurrent voice of millions who were re- 
lieved by your agency in exchanging the commodities of 
America and Europe,- during the late savage wars of the 
civilized world. 

Had you have confined the wealth you accumulated to 
the aggrandizement of your own family, to the encourage- 
ment of men of letters who would celebrate your worth, 
to the embellishment of the city of your residence ; I 
would only have said that you were, to Baltimore, what 
Lorenzo de Medici was to Florence. Had you have 
travelled about, publicly administering relief to the poor 
and oppressed, who would proclaim your beneficence to 
the world; I would only have compared you to the bene- 
volent Howard of Britain. But I verily believe, that, in 
the scale of that goodness which approximates to the 
" all beauteous mind," you greatly outweigh those distin- 
c 



guislied characters. For their deeds, the admiration of 
the world has rendered ample reward, while yours have 
been done in secret ; so, in accordance with the injunction 
of Christ, insuring the higher blessings of a happy eter- 
nity. I am conscious of violating your feelings of deli- 
cacy in referring to your charities done in private ; but 
your pain will be lessened by the fact, that the record 
gives pleasure to another, as it would the many widows 
and orphans you have relieved, under the injunction of 
secrecy. For those not knowing you, I will refer only to 
the case of a once wealthy gentleman reduced to bank- 
ruptcy, and then suddenly dying, after being appointed 
to a lucrative office which restored the hopes of his family. 
When, under a feigned name, you sent his widow so 
much money as made her entirely independent ; to the 
general question in Baltimore, " who did it?" was the 
general answer, " who would or could, but Mr. Oliver?" 
The great respect I cherish for you, in common with 
all who know you ; your kindness to the father of my 
wife, the late Mr. Stoddert, — kindness, on his account, 
extended to me, with a delicacy I can never forget — have 
induced me to inscribe this work to you. Although you 
will be indifferent about the inscription, I know you will 
rejoice if the book prove serviceable to the afflicted. You 
have now, as you have often had, my warmest prayers 
for the continuance of every blessing you can desire on 
earth, with the interminable joys of the world that is to 
come. 

THOMAS EWELL. 



PREFACE. 



"Whether popular treatises on medicine have proved more ser- 
viceable or injurious to the public, is a subject which has been 
variously viewed by some observing men. No one can doubt 
that conceited medlers have often, from their ill-timed prescriptions^ 
increased the diseases and accelerated the death of many. But it 
is evident that the injuries have arisen from the injudicious man- 
ner in which such instructions have been generally made public. 
They are not accompanied with those explanations of the princi- 
ples of medicine, which should properly govern the spirit of in- 
quiry, and the course of practice to be pursued by the reader. — 
The doses are dictated, for the names of diseases, seldom with 
any regard to the varying state of each varying system. Howe- 
ver mortifying to the pride of professional research, it is but too 
true that no certain remedy has ever been found out for any one 
complaint ; and not only from past experience, but from the na- 
ture of the human body, it may with safety be declared none will 
ever be discovered. This accounts for the innumerable contra- 
dictions in the mouths of every body, about the efficacy of particu- 
lar doses and treatment in stated cases. It should deeply impress 
on the minds of all men, the folly of prescribing and acting with- 
out reference to, or knowledge of, the condition of the patient. — 
It should constantly be remembered that the adage, " what is one 
man's meat, may be another man's poison," is not more true 
than what will cure the same man at one time, may kill him at 
another. 

But, whatever any one may think on this subject, the voice of 
the people, long since, in England, and very generally in this 
country, is decidedly in favour of popular treatises respecting the 
prevention and cure of diseases. And this voice ought long since 
to have been attended to by the more respectable part of the pro- 
fession. They appear to have laboured under the erroneous im- 
pression that it was beneath their dignity to write for the unlearn- 



xst 

ed ; losing sight of the fact, that no man could be lowered by 
acting in any serviceable station for the public : that, of whatever 
nature might be the duties, they should have felt like Plutarch, 
the pride, not of receiving, but, of giving importance to the oc- 
cupation. 

Defective as have been popular treatises respecting the preser- 
vation of health and cure of diseases, it is scarcely credible what 
numbers are annually disposed of in the United States. Such has 
been the demand, that the most contemptible productions meet 
with a ready sale. The dispersed population of the country, ren- 
dering it often actually impossible to procure, in proper time, the 
aid of physicians, makes such works almost indispensably neces- 
sary. These, to be most serviceable, should be plain, intelligible, 
and systematic ; shewing medicine, as it ought always to have 
been shewn, divested of all mystery — needing for its successful 
application to practice, no extraordinary powers— no leger-de- 
main — nothing but common sense, with common study and ob- 
servation. 

No physician, with a mind superior to the petty spirit of ac- 
quiring importance from the concealment of pretended secrets in 
the profession, would say otherwise than that he would greatly 
prefer practising in families, rational — correct — in what medical 
information they possessed, rather than in those which are 
ignorant. He feels satisfied that the knowledge of the one will 
secure a ready observance of his directions ; while the ignorance 
of the other, with its usual attendant, presumption, will be per- 
petually intruding doubts and countervailing doses. The strong- 
est tendency of correct information on the subject, among fami- 
lies, must be to create diffidence, and consequently an early appeal 
to physicians of skill. If it were followed by no other advantage 
than putting an end to applications to impostors, and to using 
medicines contrary to the indications for cure, its attainment 
would be justified under circumstances of far greater difficulty.-— 
But when forced to prescribe in the absence of physicians, the 
prescriptions of the better informed will be made with anxious 
caution — not with the audacious boldness of the pretender, which 
has destroyed ten lives for one, which have sunk from the timidity 
of prescribers. Even unassisted nature is greatly to be preferred 
to the rudeness and guessing of the ignorant. 



Xlll 

Doctor Buchan was the first English author who wrote for the 
public of his country on medicine. Probably he rendered the 
British nation more service, by his treatise on domestic medi- 
cine, than all the physicians of his age put together. His direc- 
tions for preserving health are exceedingly judicious ; those for 
the practice of physic are very tolerable, at least, for his own 
country : but his work is replete with false, absurd, exploded 
doctrines — with unnecessarily compounded prescriptions, and 
with many medicines disused, at least, in the United States. 

Our latest and greatest improvements in the medic art, arise 
from the simplification of its theories or doctrines, which has led 
to a correspondent simplicity in practice. My preceptor in medi- 
cine, the late Dr. Rush — a man most dear to the recollections of 
all who heard his lectures — was the author of the prevailing and 
increasing simplicity of theory and practice in this country.-— 
That a work on medicine is now wanted for the public, in unison 
with the doctrines of that great ornament of medical science, 
cannot be questioned. The last book of the kind published in 
the United States, is, in its directions for practice, rather better 
than any preceding ; but is excessively incumbered with compli- 
cated prescriptions. It is true, that, by the aid of recommenda- 
tions so easily obtained, and by bestowing praises on so many 
men, " spirits blue, black, and grey," it has gone through several 
editions ; notwithstanding some glaring defects in its details — * 
great ignorance of authors — much absurdity of doctrine — and an 
enormity of price, excluding it from those whose circumstances 
most require cheap instruction. It will be enough to state of the 
Work, that the fifth edition before me, having on its title page 
"greatly imfiroved" contains 649 pages, of which 178 are on the 
art of preserving health ; all of which are so full of poetry — stories 
to amuse school-boys — moral subjects — and such other irrelevant 
matter, not excepting examples of getting the brains blown out 
as proof of the health of patriotism, — all chiefly taken from the 
" Medical Extracts" published by a wild visionary, Dr. Thornton, 
(this one is of London) ; that persons would be apt to mistake the 
object of the part, were they not perpetually reminded of it on 
the top of the page. It only contains 216 pages relating to dis- 
eases : and full 168 about a Materia Medica and Dispensatory, 
of which probably as many lines would have been sufficient. It 



XIV 



is said to be, and contains internal evidence of its being, the work 
of two sorts of empiricks : the one in medicine — the other in lite- 
rature. The first, in opposition to the great Dr. Darwin, who 
taught that "to think was to theorize, and that the patient who 
had the best theorist, had the best physician;" perseveres in re- 
fusing to learn the doctrines of the medical schools, being well 
satisfied with his own very successful practice. The other is 
noted throughout the country as a kind of composer of queer 
pieces, with some original dashes of non-descript character. — 
Whether his writings be most of a moral or immoral nature, has 
not yet been determined : but his name need only be mentioned 
to excite mourning or merriment at his rapid mutations, in 
the course of one revolving moon, from preaching to peddling — 
from praying to piping at parties — from the pulpit of his church 
to the carry-all for his pamphlets. 

Indeed, it is a misfortune of no trivial kind for the literary cha- 
racter of our country, that many works beneath the tlignity of 
criticism receive the unqualified approbation of men of distinc- 
tion. Scarcely a new book appears, without having tacked to it 
letters and certificates of its excellence, which would indelibly 
disgrace those who gave them, were they not screened by their 
supposed good nature and patriotic desire to give encouragement 
to American genius. Vanity has certainly its influence with ma- 
ny of them; — the application makes distinction ; compliments 
are seasonably applied ; and, occasionally, a douceur softens the 
sting of self-condemnation for false encomiums. The case 
of a book published in New York, called the American Herbal, 
affords remarkable illustration of this. Contemptible and dis- 
graceful as is the book, it is well backed by commendators, whose 
names I do not mention from respect for their characters and sor- 
row for their folly. But it is indeed scarcely pardonable that the 
public should be gulled in matters relating to health and life : 
and the less so, when effected through the commendable spirit 
to encourage all useful productions of the country. The true 
interests of science, and the real utility of all native works of me- 
rit, are materially injured by these impositions on the credulity of 
the public. That patronage which the people could afford to 
give, is bestowed upon the pushing unworthy, instead of the 
modest worthy ; and prejudices are thereby created against sub- 



XV 

se-quent productions of Americans — prejudices, most readily 
transmitted to, and propagated by, our trans-Atlantic enemies. — 
However attached to — however connected with, the applicants 
for recommendations, it should never outweigh a regard for the 
interests of those generously confiding in the integrity of the re- 
commendator. Surely judgment, not feeling — justice, not friend- 
ship, should be exercised on such occasions. They should pre- 
tend — if they have not the reality — to have something like the 
spirit of the Consul Brutus, on ordering his rebel sons to execu- 
tion : 

" 'Tis love of honour and his country's good, 

" The consul, not the father, sheds the blood." 

For the volume now offered to the public, no recommendations 
were asked — no approbation wished, but such as each reader, 
without reference to authority, should find it deserved, after he 
had followed its directions. And the evidence of this I would on- 
ly have him shew, by giving the advice to those who know not 
its utility. It would afford me far greater pleasure to have all 
the errors erased, and all the better parts strictly attended to by 
the uninformed, than to have my vanity gratified by the praises 
of every commendator, commentator, and critic, in the country. 

A considerable part of the work is taken from one I published 
some years since, entitled " Letters to Ladies concerning them- 
selves and children." About three thousand copies were dispos- 
ed of; yet as some parts are deemed exceptionable, they are 
omitted. — Enough, however, it is hoped, is retained to enable 
women to perform the necess? t ry offices to each other in child- 
bed, without the interference of men mid-wives in common cases. 
The part relating to children is retained in its original state, ex- 
cepting some additions. As no sort of objection has been made 
to its prescriptions, I trust they will be more generally attend- 
ed to. Some parts were also taken from my Discourses on 
Chemistry, published in 1806; and much more is taken from 
the learned, "Practice of Physic," by Dr. Thomas, which I 
have freed from its technical phraseology. No one could sup- 
pose that a work of this kind could be much more than a compi- 
lation, — yet it does contain something original in matter and man- 
ner ; but its chief object is to simplify, to render more intelligible 
to the common reader, the researches of others ; to press more 



XVI 

particularly the most simple modes of preserving health antf. 
treating diseases; and to enjoin the use of what is in every body's 
power, rather than foreign articles — obtained with difficulty, often 
adulterated, and often most injudiciously applied. If the work 
succeed in these objects, I shall be satisfied to have all its original 
parts ascribed to those who have published before me. The 
style is, like that in which I have always written, irregular, con- 
taining internal evidence of no study in composition; and the 
epistolary form was preferred because most familiar. 

The reader will find but very few medicines recommended, be- 
cause in reality very few are ever wanted. Not many physi- 
cians of my age have seen, or have had more extensive practice 
than myself, in public hospitals, and particularly among poor 
people. And I have no recollection of ever having used more 
than about fifty articles properly called physic ; ten or twenty 
forming about the ordinary number. The weeds or trash with 
which the old physicians encumbered their prescriptions, and by 
which their patients often perished, are now disused by the more 
respectable part of the profession. To endeavour to afford relief 
by the judicious administration of a few medicines, is infinitely 
to be preferred to a resort to the compounded stuff of the apothe- 
cary. Indeed, it is only owing to the remains of ancient practice, 
to the prejudices of the old in its favour, that the shops are still so 
crowded with a great variety of drugs. As to the cant about 
American Medicines, Indian Specifics, and such like baits for 
the vulgar, it may be observed, that there are about ten or fifteen 
worth preserving; the rest fill space, but give no service, and, 
like the obsolete words of dictionaries, should be erased from the 
list of medicines. The noise which is every now and then made 
by those who take the subject in hand, always reminds me of men 
placed at some unimportant part of an edifice to give a little sup- 
port ; finding scarcely any thing to do, they amuse themselves 
with bawling about their arduous duties, and fain would make 
every one believe that on their shoulders rested the great work. 

Perhaps some may think it improper to blend an account of the 
management of women in labour, with the diseases of men. This 
is done in all works of the kind, and I believe it is indispen- 
sably necessary to render them generally useful. For domestic 
purposes, all medical knowledge should be equally given to men 



XV11 

and women. Females are almost always the first to prescribe 
in their families; they generally act as attendants on the sick; and 
they have collected and will continue to collect much useful infor* 
mation for the faculty. On the other hand, their husbands should 
be their nurses, and equally exercise their abilities in attending 
to them, even in child-bed. Instead of their remaining in some 
distant room, grinning at good and groaning at bad reports of 
the state of their wives, they should follow the example of the 
Emperor Napoleon, on the accouchment of his Empress Maria 
stay at the bedside of their wives, and render all the assist- 
ance in their power. They might, at all events, prevent the 
injudicious interference and destructive violence of medlers, while 
their sympathy would alleviate the sorrows of the suiferers. 

If there be a country where medical information ought to be 
diffused, it is in the United States, where professional services are 
so often dilatory and out of time. If there be a part of the com- 
munity to whom this knowledge should be confined, it is, assured- 
ly, the female part, — at least concerning themselves and children. 
Their delicacy of frame, and sensibility of system, leading to 
speedy termination of disorders, renders this knowledge, by them, 
not of questionable value, but of most important benefit. Instead 
of giving articles to the sick in their families, contrary to proper 
treatment, or withholding some little remedy, equal to the cure 
in the commencement, they might, without much intellectual 
exertion, acquire such knowledge as would insure essential ser- 
vice — at least until the arrival of physicians. The more they at- 
tend to such knowledge, they will be endeared the more ; and be, 
as they should, alike contributory to the interests and to the plea- 
sures of man. 

To ladies of good candid minds, no apology will be necessary 
for the plain manner in which I have stated some subjects, deem- 
ed offensive to converse about, yet important to health. Only 
those of affectation of feeling, can fancy there is indelicacy in un- 
derstanding what may save from exposure, disease, and death.-— 
I was pleased with a French lady, who, shortly after her arrival 
in my neighbourhood, sent in the night for a physician to her 
child, suddenly taken alarmingly ill : on his entrance, observing 
her nearly half naked, he was about withdrawing, when the 
earnest mother exclaimed, in broken English, — " Sacrez ! fool 
C 



Doctor — you let my child die cause I no dressed.'* It is certain, 
that the mind in private, with perfect purity, turns to every point; 
and instead of seizing at extraordinary means on emergencies, 
we should deliberately, previously acquire qualifications for act- 
ing. I am conscious of pressing into this work several practi- 
ces, which many of the respectable part of the community are in 
the habit of observing, without the advice of a physician. Such 
directions are offered only to those who do not observe them, and 
the more earnestly to induce those who do, to assist in inculcating 
them among the negligent and uninformed. To produce the 
stronger impressions in other cases, I have purposely repeated 
the same advice. 

An essential part of the education of every male and female, in 
my opinion, should be a general knowledge of the outlines of the 
nature of their bodies, and the principles of the cure of their dis- 
orders. Not for the purpose of practising physic, but to enlarge 
the mind ; to habituate it to think rationally on the subject, and 
to guard against the innumerable impositions of quacks, as well 
those who advertise as such, as those of vast boasting expe- 
rience — deceptious only to the ignorant. Had but the slightest 
knowledge been cultivated on these points, the world would never 
have been festered with the innumerable and preposterous 
accounts of doses " for thinning the blood, for correcting the bile> 
for purifying the urine," and for the like ridiculous objects. It 
is well known how greatly the science of chemistry has improved 
since the introduction of proper names ; and the same would 
take place in medicine, if the same accuracy were observed.— 
Most of the improvements in medicine were discovered by the 
common people ; and how much greater these must have been, 
had they understood the principles of the science. The persons 
feeling the disorders must more accurately describe their varying 
stages, and the effect of medicines, than their attendants can pos- 
sibly do. 

It must be a very contracted or narrow-minded physician, who 
thinks that the interests of the profession can be injured by dif- 
fusing medical knowledge among the common people. The 
forms of law and of religion are open for the inspection of all; yet 
there are as many lawyers and priests now, as when those profes- 
sions were enveloped in mysterious garb. We have every reason 



XIX 

\ r "■>'-. 

* TT I / 

to believe that the result would be similar if a knowledge of me- 
dicine were equally diffused. When we see our first physicians, 
in sickness among themselves and in their families, calling on 
each other for medical advice, can we doubt that such would 
be the call of every man who had only the superficial view of the 
subject which could be derived from reading one or two popular 
and general views of the subject ? In short, the real interests of 
the profession must be promoted by a diffusion of medical know- 
ledge : for, it will excite a correspondent desire to employ, in 
sickness, the more intelligent part of the faculty. The sooner it 
is freed from its lumber of impostors-— to whom the door of 
admission is now so widely opened — the sooner will it ged rid of 
the opprobrium with which it has so long been oppressed: the 
sooner will merit rise to respectability, independece, and useful- 
ness. 



C 



U 






i^ilQ) 



ADDRESS L 
PRESERVATION OF HEALTH. 

PART I. RESPECTING INFANTS. 
To Mothers. 

As the foundation of many of the diseases of the human body 
is made in infancy, it appears proper to commence my observa- 
tions for the preservation of health by the treatment of children. 
It is a subject about which a great variety of notions have been 
entertained, in consequence of the general failure to attend to the 
course pointed out by nature, and pursued by all animals below 
the human. It ought to be well understood by all mothers, to 
enable them to direct, if not perform, the necessary duties, with- 
out a dependance upon ignorant nurses or attendants. The vari- 
ety of plans recommended, and modes adopted, would fill a vo- 
lume. Even the stupid would be astonished to observe some 
kinds of treatment, different from that which they follow, proba- 
bly of not worse tendency than their own usages. Every mid- 
wife and every family appear to have some peculiarity in the 
treatment of children. Surely the whole of them will have to 
account for the injuries they have done to babes, if we have ever 
to account for follies which might have been avoided by the ex- 
ercise of our natural sense. As an example of such follies, in one 
of the most intelligent families I have ever seen, the midwife was 
allowed, at every birth, on first dressing the child, to hold it up 
by the heels, and give it a shake ! then a moderate dose of bran- 
dy and water : this stimulus, aided with sugar and nutmeg, was 



poured down the throat I Indeed, almost in every house, I have 
been struck with the infatuation that prevails on such occasions ; 
something must be given! every thing appearing, but good com- 
mon sense. Because the business of generation seems so myste- 
rious, something extraordinary is supposed to exist in every de- 
partment! To break the spell, to put down the preposterous 
boast of experience among old nurses, and some mothers ; to teach 
the bystanders, that the bodies of the little babes are subject to 
the same'laws as their own, becomes important, from the singu- 
lar infatuation prevailing on the subject. If the little innocents 
could speak, they would tell you, they knew no difference between 
being disordered and destroyed by intended kindness, or by in- 
tended neglect. 

In the hope that you will yield to reason ; with the earnest en- 
treaty, that, for the sake of humanity, you will conform to the 
course pointed out and confirmed by the most successful practice 
of the greatest physicians, I proceed to state the directions for 
the treatment of children which should govern every woman. 

When the child is separated from the mother, the utmost care 
is to be taken to prevent its receiving colds. These colds affect it 
most seriously, producing inflammations of a destructive kind, in 
the lungs and bowels. In order to guard against them, the child 
should be received in a warm flannel, having an opening to breathe, 
and kept in a warm place, where no cool air can have access, un- 
til warm water is procured for washing it. Never use cold water 
for the purpose, and nothing but warm water. By gently washing 
it in warm water, the matter adhering to the skin will come off, 
if not the first, the succeeding day. It is to be kept in the water a 
few minutes, undergoing this gentle washing, and to have a linen 
rag put on its navel — a burnt rag, or any charcoal, might be first 
applied to lessen the offensive smell of the part that comes off. — 
Generally there is a sore, made by the nutmeg and other trash 
foolishly applied ; there will be none, if the parts are dressed with 
simple sweet oil, or hog's lard, after the separation of the cord, 
which takes place about the sixth day ; no irritating matter, no- 
thing but something mild, is wanted to exclude the air from the 
surface. After a linen rag is applied to the navel, a band is to be 
put around the belly, not tight by any means, as compression of 
the belly will be injurious. The next object is, to dress the 



23 

child : no clout is necessary to be put on ; the child can't turn, 
and simply putting- a cloth under is sufficient for a month ; its 
clothes should be of linen — no pins to secure them, but strings ; 
never allow its limbs to be confined ; the more it can use every 
part, the sooner will it strengthen. Under no circumstances, 
should any thing be applied that presses on any part. A tight 
bandage will cause the absorption of the hardest parts of adults ; 
and how much more destructive to children ? The best article, 
for some time, is simply as was put on our Saviour, a swaddling 
cloth ; and afterwards, instead of keeping the child screaming, as 
is universally done, with the ridiculous pieces of clothing — 
shirts, petticoats, and the like evidences of folly; let it have no- 
thing but one pelisse, as thick or as thin as the season requires, 
which can be put on in an instant, and made as fine as the parent 
can afford for the gratification of vanity. 

The child being dressed, it requires nothing more than to be 
laid down, level, to repose quietly. From the fifth to the tenth 
hour after birth, it should always be applied to the breast of the 
mother. It wants nothing else ; the milk is its physic, and its 
best nourishment. You will observe the redness of the skin, 
sometimes blisters, and extreme irritability in every part. These 
are symptoms of its inflammatory state ; and these, exclusive of 
experience, proclaim the folly of giving it other stimulants, drinks, 
or mixtures, to add to the too much excited action of its body. 
It wants nothing but its mother's milk, for which it should be 
applied to the breast in the time above directed. The first dis- 
charge from the breast will, in all probability, open its bowels in 
sufficient time. If the bowels be not opened the second day, 
pushing gently, half an inch up the fundament, a small quill co- 
vered with an oiled rag, will produce the evacuation ; in case of 
failure, a tea-spoonful of sweet oil poured down its throat, to 
repeated in three hours, if the first be not successful ; lastly, 
continued failure, a tea-spoonful of castor-oil, or a little man: 
might be given on the third day. I never knew the introducti 
of the pipe, as above advised, to fail in producing an evacuati< 
It is always to be preferred to giving medicine. 

It will not be necessary to refer to the medical part, the tre 
ment of the small blisters, swellings, and inflammations, wh: 
are so apt to appear on the skin, and parts compressed at bij 



m 

The cure is to be effected, by not touching them ; some prefer 
puncturing- the blister with a sharp needle, so as to let out the 
water, without letting in air ; — a cold, wet rag, applied for a few 
minutes, will expedite the dispersion of the swellings. For other 
complaints, I refer to the medical treatment. 

The rules for nourishing children are, never for sixty or seven- 
ty days, give any thing but the mother's milk ; in the beginning, 
give the breast every three or four hours. Some have urged to 
begin with establishing hours for this supply ; but they mistake. 
The habit is best acquired weeks after. In the womb its body 
was slowly and constantly nourished ; and we should imitate, by 
having in its stomach always a little, never much at a time. I 
suppose the means I shall hereafter recommend for exciting the 
breasts, will be used to insure the supply of milk. But if acci- 
dental causes should render it impossible for the mother to give 
milk, then, as the lesser evil, some woman should be procured 
who can yield the supply. Giving infants other food, has done 
incredible mischief. No other animal requires aught but the 
mother's milk ; yet there is scarcely a midwife or nurse in the 
country, who is not for pouring down the child's throat, soon- 
after its birth, some of their mixtures. There is not one of these 
compounds that does good. They pretend they give very little ; 
then the very little can be of no service* — never yielding a fiftieth 
part of the nourishment taken away by its acting as irritating 
substances in the bowels. Instead of giving up the early treat- 
ment of children to such attendants, there is stronger reason then 
than in subsequent advanced stages, for the mothers and friends 
to exert all their senses on the subject. Follow nature ; I cannot 
impress on you too much. Nature never intended, that, for your 
child's accommodation at birth, a ship should have to sail to the 
East Indies for nutmegs, and another to the West Indies for spi- 
rit and sugar, to make the almost universal doses given to chil- 
dren. Nature could hardly have provided against such abomina- 
ble outrage on its laws : to add to this sugar and water, and nut- 
meg, the intoxicating liquors, is shameful in the extreme. If 
there be not enough milk in the mother's breast, and another 
nurse cannot be had, then give the like — cow's milk newly drawn, 
mixed one-third with warm water, with very little, if any, sugar. 
After sixty or seventy days at least, the child may then properly 



25 

■have its diet changed : first, it is best for some other woman oc- 
casionally to suckle it, then the mixture above mentioned, and 
then milk alone, until all the common articles of our diet may be 
administered in gradual succession. 

The periods of feeding the child should be regulated about 
this time ; beginning to let it suck very late at night and early in 
the morning. After a week or two, the breasts may well be 
withheld during the night, by degrees reducing the times of 
feeding to four or five times a day. It is so important, that I 
would impress it an hundred times — most gradually make every 
change in the child's diet. Begin with the mildest articles, and 
but in small quantities ; the article you begin with, persevere in 
its use, unless powerful reasons prevent, until the child is habitu- 
ated to it. I repeat the remark, one sound, healthy article is near- 
ly as good as another. Boiled milk diluted, and bread, or arrow 
root, or sago, are excellent articles to commence with : weeks 
after, soups and boiled meats may be substituted. 

On the subject of raising children without the breast, Dr. Burns 
says, " a mixture of cow's milk, water and sugar, has been used 
as a substitute for breast milk. But more advantage will be de- 
rived, by adding to cow's milk, a third part of new made whey, 
(not made by wine,) with a sixth part of sweet cream and a little 
sugar. Whey, with the addition of cream, and very little sugar, 
without milk, may also be employed." Children have been 
reared tolerably well on these mixtures, without the breast, though 
never as well without as with it ; which is a strong reason why 
wet nurses should be got if possible. Dr. Moss says, that an ex- 
cellent substitute for breast milk is the milk of a cow, (the cow 
should never be changed,) drawn whenever wanted, and mixed 
with one-third warm water, not to be boiled. The addition of su- 
gar is not needed ; better without any, but if any, let it be but lit- 
tle, as the stimulus of the sugar is too strong for the bowels, and 
often produces disease. It is more incumbent not to change the 
diet of children brought up at the spoon, than those at the breast, 
as their bowels are very irritable. Whenever their stools become 
very offensive, you may rely upon it that they are diseased ; in 
nine times out of ten, from somethingdefective in their diet, often 
from quantity as quality. Whenever any diet disagrees witjx 
D 



26 

them, it should be discontinued, and a physician consulted fo? 
directions. 

In feeding with the spoon, care should be taken not to feed until 
the child ceases to eat ; a little often is better than much at oncej 
the jaws tire while sucking', but not so much in taking from the 
spoon. 

With respect to the time of moving the child, Dr. Moss re- 
marks, that warmth and rest are indispensably necessary for in- 
fants at an early age. " In the first week, it should not be car- 
ried out of the room ; not till the end of the second week, should 
it be carried out — and then only to adjoining apartments. About 
this time, the child, if it do not appear disagreeable to it, may 
have its skin rubbed gently with the hand, its legs and arms 
stretched ; it may be handled once or twice a day, for a little 
time, on the nurse's knee, near the fire. During the third 'week, 
the time of the child's being up and out of bed may be lengthen- 
ed ; and after this, its other exercises are to be conducted by de- 
grees. In the beginning, great caution should be observed in 
carrying the child into strong light, and a damp air." 

Many women feel considerable anxiety on the subject of the 
influence of their diet on their children's health, especially in 
early infancy. They fancy that the physic they take enters into 
their milk, and operates on the child as on themselves ; but thi^ 
is a mistake ;-— and it is folly in a mother to swallow medicines 
for the purpose of affecting the child. Now it is a truth, that 
whatever affects the stomach of the mother, affects her milk ; 
and whenever changes in the milk are made, they affect the 
child, not by any means, however, always in the manner they 
operate on the mother* If the mother change her diet, or drink, 
or take any medicine, or get in a violent rage, or have a fever, 
unless the child be unusually healthy, it will be affected by the 
alteration wrought in the milk : generally purging will be excited, 
just as it will be, if any foreign, irritating substance is given to 
the child. From this an important inference should be drawn 
by mothers : they should learn to adhere to one diet, to be regu- 
lar in their habits, to preserve their tempers while their children 
are at the breast; at least until their constitutions are well im- 
proved. Those who have delicate children, should of course pay 



27 

tlie more attention to this subject. I will only add, the best milk 
is given by those females who preserve their health by simple 
diet, taking only the stimulus of exercise and pure air. 

There is no treatment of children found so certainly beneficial, 
as washing them all over every morning in a tub of warm water, 
from the day of their birth, till they have passed two years of age. 
It is a luxury every woman can afford for her child ; indeed, they 
will find economy in its use. The free motion of its limbs in 
water, contributes to its health. The circulation of its system is 
greater than ours, and therefore in proportion it has more excre- 
tions. These excretions are more apt to become acrid and irritat- 
ing than those of grown persons. It is therefore most important 
to immerse them daily in warm water, that the surface of their 
bodies may be kept clean. Moreover, the warm water tends to 
equalize the action of all parts of their systems, on which equali- 
zation depends their health, I never knew children subject to 
irruptions, nor one-tenth so sickly, when daily made to sit, im- 
mersed from neck to toe, in warm water, as others under the 
same circumstances, excepting the washing. If you be a fond mot 
ther, half of either reason I have given will induce you to attend 
to the prescription. You will be delighted at witnessing the 
pleasure the child shows in the bath, and much more at the con- 
sequent exemption from disease. If you be a friend to humanity, 
most earnestly entreat every mother, the poor and the ignorant, 
to adopt the practice ; remind them of the facility of warming 
water with hot stones or irons, and many will be the lives saved. 
Nothing but severe illness, should ever postpone the daily opera- 
tion. 

Some persons have recommended the bathing children in cold 
water, but the shock is too severe ; it has been the death of many. 
Nevertheless, many have improved under its operation. I know 
that the warm bath is best, and I cannot see the least reason for. 
using the cold, excepting the incorrigible laziness of those who 
neglect to warm the water. The advantages of a momentary 
shock to the skin, are abundantly derived from exposure to cool 
air, during the wiping. The astonishing improvement I have 
seen so many interesting little children derive from its introduce 
tion, for which important practice much is due to the zeal and 
benevolence of Doctor Buchan, induces me earnestly to beseech 



38 

every mother to let hereafter a tub of warm water be the first ar* 
tide brought to her children in the morning. 

The question of the propriety of rocking children in cradles?, 
has been considerably discussed ; many doctors urging that the 
rolling motion stupefies : all nurses urging the great convenience 
of the practice. I am certain, that the gentle rocking of a cradle^ 
at a proper time, will not be injurious. It should always be most 
gentle, never allowed by its violence to drown the cries of the 
child ; never to be done when the child is diseased. It is indis- 
pensable for the cure of children's complaints, as well as for our 
own, that they should have rest. When they cry from the pains 
of disorders, rocking them is excessively injurious ; and unless the 
nurse is cautioned and bound not to rock a child crying from pain, 
there had better be no cradles. But these cradles probably never 
did as much harm as shaking the child on the knee, in the way 
that is so universal, even in the earliest days of infancy. The 
agitation, most certainly in the state in which the brain then is, 
must have aided in impairing the faculties of so many. An inva- 
riable rule should be with mothers, never to let a child cry with- 
out examining and turning it over to rest on another part. 

The next subject is, the proper place for children to sleep in 
cold seasons. There is a strong feeling to take the child in the 
bed, although many have been destroyed by the intended kindness. 
Yet I will assert, that not one has lost its life by the practice, for 
five that have died by the diseases brought on by the coldness and 
dampness of the cradle. There can be no doubt, that a great 
cause of the fatality among children, is their suffering while in the 
eradle alone. We, in our beds, frequently are unable to preserve 
our warmth ; and no wonder the extremities of children are so 
often found cold. All mothers in a natural state sleep with their 
young ; the heat of their bodies appears essential for keeping up 
that of their offspring. Excepting among hogs, I never heard of 
their being suffocated by the bodies of their parents ; and why 
should not women be able to guard against such a misfortune ?— ■ 
A variety of expedients could be adopted to have the warmth of 
the mother, without endangering the life of the child. The most 
simple, practicable plan, which presents itself to my mind, is, to 
have a small plank, but little larger than the child, its edges sur- 
rounded with a few pegs, eight or ten inches high, and the little 



£9 

oed to be put in it. An advantage really worth attending to, 
would be derived by having the little bed of the child stuffed with 
powdered charcoal. This will correct the disgusting smell of 
the urine, which makes so many beds disagreeable, often driving 
the husbands to seek purer quarters. Unimportant as this may 
appear to some habituated to the stench of stale urine, I feel con- 
fident that it would save many from adulterous practices, and con- 
tribute to the health of children. Any contrivance may be made 
to prevent the turning over to the mother ; the pegs will prevent 
her turning over on it. Those who can afford it, can have the 
contrivance made of as fine materials as they please. The expe- 
dient will answer for the rich and poor, the mistress and the slave; 
the necessary expense not being ten cents, I would earnestly en- 
treat every mother desirous of giving comfort to her child, to 
adopt the plan. It will save children from many diseases, as well 
as pains; and it will be a convenience to mothers to have them so 
near, for the purpose of giving the breast, and applying clean 
cloths. 

Next I have to request your attention to the daily evacuation of 
your children's bowels. If there be no improper cramming of the 
child, no sickness; once or twice every day, at stated hours, will 
be sufficient. The advantages derived from the cleanliness of the 
habit, should induce every nurse to attend to it. It will super- 
sede the use of the clout in almost every case : a great relief to 
mother and child. The simplicity of the modes of bringing on 
the habit, is such, that I feel almost tempted to advise giving a 
grain or two of some powder along with it, that you might think 
the dose did the business. But I shall rely on your better sense. 
The means of effecting this regularity of habit in the child, are 
precisely the same as in our own case. Turn Wp its posteriors to 
cold air every day at the same hour ; let nothings-prevent ; if ne- 
cessary, twice a day, morning and night : at first introduce an 
oiled rag around a small quill; some months after, a piece of soap 
may be substituted ; keep it there till the evacuation is made. — 
After a little perseverance, (if you will not forget once or twice, 
and let the habit be lost,) the child will daily discharge its excre- 
ment at the same hour. You may rely upon the success of this 
treatment in every case, and at all times, except when disease is 
existing. It will greatly contribute to the health of the child, by 



30 

preventing the retention of offensive matter in its bowels, which if 
sometimes forgets to evacuate. Moreover, children are often 
afraid to evacuate, because, being great observers of the counte- 
nance, they see the displeasure and uneasy feelings frequently 
excited at the ill-timed deposit. They retain till they can retain 
no longer, and often show sorrow, not at the bad habit disordering 
their delicate bodies, but that at last they are obliged to evacuate. 
It is the nurse, not the child, that in all cases should be condemned. 

I have now to urge for your consideration, the proper use of air 
for children. They, in proportion to their bodies-, require more 
and purer air than older persons. A confined air is more pestife- 
rous to them than the most fatal epidemics. The difference in the 
deaths and diseases of town and country children, establish this 
beyond doubt. Probably an occasional breathing of a pure at- 
mosphere, is more injurious than habitual confinement to one that 
is defective. Children in very tight houses are never so healthy 
as those in open buildings : their diseases are more violent; they 
feel every change of weather. It is equally remarkable, that, al- 
though they be more healthy in houses of loose joints, in which the 
.air can penetrate, than in those that more effectually exclude the 
air, they never do well, exposed to cold and currents of wind. — 
They require an abundance of pure air, and their bodies to be 
kept warm. Indeed, it seems incomprehensible how so many 
children have survived confinement to the air of close rooms, 
corrupted by their parents, companions, and servants; a cvcr&d 
which may frequently be found in the rooms of some very weal- 
thy persons, ridiculously afraid to trust their children out of 
their bed-rooms. All parents should bear in mind, that their 
children cannot enjoy perfect health, without having good, whole- 
some air for their lungs, and warm clothing for their bodies. — 
There should be never more than three to sleep in a room of less 
than twelve feet square, with a door, chimney, and loose jointed 
window. 

Warm clothing in cold weather, is nearly as essential for the 
health of children as fresh air ; comfortable, not oppressive cloth- 
ing. Let their clothes be changed to suit, not only the varying- 
seasons, but the changes in the day, in spring and fall. It is at. 
these times they arc most subject to disease ; therefore clothing 
to suit the day is almost more essential than in the coldest sea- 



31 

sons* The fantastic manner in which many mothers dress their 
children — arms and breasts exposed, in cold seasons — betrays as 
much want of sense, as ridiculous vanity. This excessive folly is 
sometimes defended, with the pretence of hardening their children. 
Just as the old generals prepared their soldiers for fatigues they 
might never encounter; killing about the half in hardening. There 
can be but little doubt that a great number of children have been 
sacrificed to such schemes of hardening. Better commanders 
now reserve their men until the time comes for exposure, and so 
should our better mothers do. You will misunderstand me, if 
you infer that I wish parents to bring up their children with 
oppressive care and kindness ; destroying them with daily con- 
finement to close rooms, only taking exercise by rules, and with 
covering enough to weigh them down. There is a medium in 
all things, to be settled by exercising common sense, without a 
bias to any particular system. It is by this that we may all 
ascertain the best method for rearing children, neither with exces- 
sive care or neglect. Free exercise in open air, with comfortable 
clothing for all parts of the body ; a frequent, but not a long in- 
dulgence in the plays of childhood, while the weather is bad, are 
outlines of management, which all of sound mind must approve. 
We must not deny the propriety of the course, if, in a few cases, 
we see exceptions to its success. Tendencies to disease are some- 
times produced by causes very likely to escape our observation. 
A too confined or crowded room to sleep in, eating too much of 
an unusual food, for example, have frequently produced the com- 
plaint, that the over careful have ascribed to their children's expo- 
sure. Exposure to rains, and more especially exposure to a hot 
sun, have had great influence in making so many excessively par- 
ticular about their offspring. They restrain the proper playful 
pursuits of children, because other children have suffered— and 
often from what the beasts of the field take very great care t© 
guard against, that is, exposure to rains, and most to a summer's 
sun. That children in our country, in the months of June, July, 
August, and September, survive two hours' exposure to the 
rays of the sun, which so frequently kill the most vigorous men 
in a few hours, is to me unaccountable; and I could not believe 
that they do it without perceptible injury, but that I have seen 
ihem escape. Rely not, affectionate mothers, on such escapes! 



32 

£eep your children from exposure to rains, and particularly 
a hot sun, as you would from a raging fire, or pestilential 
atmosphere; often warn them of the dangers in the beginning, 
and they will habitually shun them: Let all of them play as much 
as they desire in shades, uncontroled, with clothing suitable for 
the day, and with pure air for their respiration; and by such means 
you will save millions of your offspring from premature disease 
and death. 

Another important point I would press parents to observe, is, a 
never varying simplicity of diet for their children, at least in the 
early stages of life, aided by great regularity in eating, and indeed 
in all other habits. The numerous specimens we daily see of dis- 
tempered, distorted people, owe their existence to parents disre- 
garding such regularity. Strange as it may appear, 'tis self- 
ishness, 'tis extreme of weakness, that has led to these perni- 
cious practices to the contrary. Children are perpetually inclin- 
ed to be doing something: when not at play, they refer to eating; 
and the father and mother find more pleasure in giving than in 
restraining. They but seldom encounter the labour of thinking 
of consequences; and the child is not only allowed to eat until dis- 
tension becomes painful, but it takes sometimes the most stimu^ 
lating food; frequently is excited by compounds — most generally 
with that favourite article, found in so many houses, commonly 
called CAKE. This abominable compound, first used only for 
the purpose of stimulating the worn-out stomachs of the intem- 
perate, has disordered and destroyed millions of children. Either 
of its component parts, separately taken, is healthy; it is when 
compounded, that they are pernicious. The appetite for it, is 
artificial; and as children have the strongest relish for the most 
simple food, when confined to it, (as for the mother's, milk,) it is 
infinitely better that they should never have such excitements. — 
It ought not to be allowed, if for no other reason, than the uneasy 
feeling many other children have, in not partaking of an article 
deemed so good. I have no hesitation in declaring that its use is 
as pernicious as dram-drinking; that no child under five years, 
ever ate it without injury visible or secret to its constitution. 
You may perceive how powerfully the compound operates, by 
having two children under the same circumstances, both accus- 
tomed to simple diet; give the one at night cake to eat, none to 



33 

the other; watch the sleeping: and the starts, the restlesness, if 
not the screams, will proclaim which took the disordering com- 
pound. Sweetened light bread is the substitute, but no substitute 
is wanted; the more simple, the more agreeable will be. the diet. 

Children ought never to be allowed to eat too much: the means 
of preventing such gluttony, is to give them some light article to 
eat, before their regular meals, which prevents that eagerness to 
eat, which naturally leads to excess. They should always, the 
moment they awake, take a little food. In giving them new arti- 
cles of diet, the commencement should be with small quanti- 
ties, to habituate the stomach to its digestion. It is excesses, 
compounds, and irregularities in diet, which have produced so 
many small persons. A return to the simple diet of the ancients, 
would be followed by a restoration of the size of our species. 

The time for weaning children, generally the critical time of 
teething, is next to be noticed. This varies in every country; 
indeed in each family so considerably, that it is impossible to give 
any thing satisfactory on the subject. The general rules are, by 
all means to habituate the child for weeks before to a different 
diet; by no means suddenly to withhold the breast. Next, the 
time for weaning should always be when the child is in a 
healthy state. The substitute for its diet, ought at first to be 
that which was recommended for children in early infancy— the 
mildest articles. Children have done well when weaned at the 
fourth month; but unless some disability of the mother renders it 
improper, it is best not to deprive them of the breast before the 
ninth month. When the parents are of small stature, it is best to 
keep the child longest at the breast, as in all other animals it ap- 
pears to have the effect of increasing their size. Judging from 
comparison, and from a few observations, I have no doubt such a 
course, not destroyed by stimulating diet, or drinks, or premature 
venery, would have the effect of greatly enlarging our puny breed 
of men and women. 

The next subject for consideration is the teething of children; 
an operation which has probably caused the death of more chil- 
dren than any one to which they are liable; and all from the igno- 
rance and fears of the attendants, often supported by the conceits 
of their physicians. The important connection between the mouth 
and all parts of the body, will hereafter be particularly exempli- 
E 



34 

fied. It is not surprising, that such great variety of diseases 
should follow the irritation in the mouth during teething. 

The time of cutting the first teeth is irregular — from the third 
to the fifteenth month, generally between the seventh and ninth. 
There are two stages in this operation; the first is about the third 
or fourth month, marked by slavering, when the child delights in 
having its gums rubbed; sometimes they have fevers, fretfulness, 
and diseases of the bowels. The second stage is about the seventh 
month, when the teeth are penetrating the gums. The gum is 
swelled, and too painful to allow the slightest touch; as the tooth 
is about to appear, a white blister appears over it. 

Children have often most difficulty in cutting the first teeth, 
which, if they come in proper order, are the two lower front 
teeth, then the two above them; butAvhen the usual time of cut- 
ing has past, the two upper teeth will sometimes appear first, 
then the two eye teeth; but the appearance is very irregular, and 
not material. About the seventh year, these teeth give place to 
new teeth. In order to prevent the diseases so often attendant 
upon teething, it is necessary to watch the first symptoms of dis- 
ease, and invariably to scarify or cut the gum, at the same time 
giving some laxative medicine, and lessening the diet. In the 
first stage, it may be difficult to discover which gum ought to be 
cut, but when disease is violent, it is best to cu.t all over the gums 
in front. Whenever the gums are swelled, it is then of the ut- 
most importance to cut them freely ; a common pen-knife, or 
thumb lancet, will answer, and any mother's or father's hands, 
just as well as a surgeon's. The first object is to draw blood 
from the part; then, if the symptoms continue bad, to cut down 
to the top of the tooth. There is no danger of hurting the child; 
indeed, such is the relief derived, that children often open their 
mouths for the operation. Their gums are very insensible, ex- 
cepting when, from neglect to scarify them, they are inflamed. — 
Nor need you be afraid of hurting the teeth, as they ascend, cover- 
ed with their enamel. 

A ridiculous idea prevailed among physicians for some time, 
that cutting the gum gave present relief, at the expense of future 
pain; that the scar formed when the wound healed, was more dif- 
ficult of penetration by the teeth. To this day, some are ignorant 
enough to believe in the doctrine, and refrain from relieving the. 



35 

sufferers, as though their gums could not be cut every day, if 
necessary, even were their notions true. But the fact is the re- 
verse. All new formed parts are more easily destroyed than old; 
they more readily dissolve, or disappear, as instanced in the cica- 
trix, or new formed flesh of old sores. To cut a gum over a tooth 
which has not appeared to rise, is therefore rather of service than 
injury to its future passage. One of the greatest surgeons who 
ever lived, Mr. John Hunter, of London, writes, " it often hap- 
pens, particularly when the operation of cutting the gums is per- 
formed early in the disease, that the gum will re-unite over the 
teeth; in which case, the same symptoms will be produced, and 
they must be removed by the same method. I have performed 
the operation above ten*times upon the same teeth, when the dis- 
ease had recurred so often, and every time with the removal of 
the symptoms. " 

I do sincerely wish I could prevail on all mothers or fathers to 
undertake this gum lancing. Nothing is more simple, or more 
easily performed; it never does harm, and it would so much les- 
sen the sufferings of the little children, that I should be happy in 
the recollection. It is best for the child to cry when lancing the 
gum, as the mouth is then most opened, and the cut may be di- 
rectly on the top of the tooth. In some cases, where there is rea- 
son to believe the teeth to be advancing, yet no visible sign, great 
relief has been obtained by cutting down to where the tooth should 
be; thereby letting out blood, with probably some little irritating 
matter, producing violent action in the system. If you will not 
do it yourselves, I beseech you to insist on your physician fre- 
quently performing the operation. 

I have not dwelt upon the diseases incident to teething, because 
they are so numerous, and vary almost in every child. The most 
common are, affections of the bowels and convulsions. When 
these or other violent complaints appear, or are apprehended, the 
child should be blooded, by cupping about the lower extremities? 
and purges given, with the warm bath, (not hot,) to take off 
the irritation. The gums, of course, to be freely lanced. The 
rule I have adopted, and would prescribe to all, is, whatever may 
be the inflammatory affection of the child, if it have slavered 
freely, before, or if it be the time for the teeth to appear, by all 
means to cut the gums, so that they shall bleed freely. 



86 

All parents should be apprised of the importance of teaching 
their children how to command their own minds in early life. — 
The numerous ungovernable spirits we see daily in society, ori- 
ginate from the folly of neglecting this important object. I make 
the assertion in the fullest confidence of its truth-— that there is no 
child which cannot be trained, and with but little trouble, to any 
habits of self-command. It only requires a good beginning.— 
The first correct practice is to prevent their getting into the 
habit of crying; to make them suppress their cries, at least loud 
crying; which is not only horribly annoying to others, but calcu- 
lated to produce convulsions in the child. Whenever they are 
heard to cry, inquiry should be made into the cause, and their at- 
tention directed to some other point. A little perseverance in 
the beginning, will soon be crowned with success; and it is in- 
deed worth a long attention. The ability to suppress cries, will 
be followed by ability to command other feelings. The example 
of submission in the eldest child, will have great influence over 
the younger; so much, that half the discipline will suffice with 
them. Children so brought up, do not require or receive a tenth 
part of the correction of those punished irregularly, or, as it is 
termed, by fits and starts. The practice I have pursued with my 
children has been, to begin early with punishment; never to suf- 
fer disobedience in the slightest degree; never to withhold one 
proper gratification they desired; never to allow one that was im- 
proper; and the consequence has been, that no children less fre- 
quently require punishment. 

In concluding this, I feel some pain at the apprehension, that 
I have not said enough to induce a strict adherence to the practi- 
ces recommended. I knew them to be so judicious, that I felt 
as if argument were useless. The subject is those of whom our 
Christ declared, " of such is the kingdom of Heaven!" If you 
feel as parents, if you have souls to partake of the heaven of do- 
ing good to innocence, you will not require long arguments 
to adopt practices promotive of the health of children. I ask — I 
pray you — if I have not urged sufficiently to induce you to do it, 
then, as a favour, as a kind compliance, in return for the wish I 
have to serve, immediately prescribe — 

1. That in cold weather, all little babes shall sleep with their 
mothers or nurses, in the safe manner pointed out. 



37 

2. That until their constitutions are formed, their diet shall be 
simple, and of the same kind. 

3. That they shall be kept warmly clothed; never allowed to 
sleep in a foul, close air; nor with windows open. 

4. That every morning-, from birth, for at least two or three 
years, they shall be put in a tub of warm water and washed. 

5. That they shall be, as far as practicable, got in the habit of 
evacuating their bowels at the same hour. 

6. Lastly, that whenever their gums appear in the least inflam- 
ed, you will cut, or will have them freely and often cut. 



PART II. 



Preservation of Health after Infancy, 

Having concluded the observations I had to make respecting 
the treatment of infants, I proceed to consider the best means of 
preserving health, subsequent to our first stage of existence; and 
as there is nothing of more importance for our lives than the air 
we breathe, it is proper to commence with our 

ATMOSPHERE. 

We are surrounded by an invisible fluid, which but a little ob^ 
servation teaches us is subject to great variations in its qualities 
perceptible to our senses, as well as those which are not ascer- 
tainable but by particular investigation. These last relate to its 
composition of four different ingredients, which will be stated 
after the sensible qualities of cold, hot, dry, and damp air, are 
considered. 

It will be unnecessary for me to quote authorities to shew you, 
that man can be found in a tolerable state of existence in almost 
the very extremes of., these different states of air: in the almost 



38 

eternally frozen regions of the North; under the perpendicular- 
rays of a burning sun, near the equator, where the heat seems to 
threaten a general conflagration; in countries where it never rains, 
as in parts of Africa; and in others, where it so rains as to endan- 
ger a general deluge. But, notwithstanding the existence of man 
in such opposite states, he enjoys his most perfect health and 
greatest longevity in the temperate and regular climates; where 
he suffers only in proportion to the vicissitudes, to the changes 
from one state to another. 

There are probably but few countries where changes in the air 
are more rapid, than in the United States. Seldom does a month 
pass over, without fires being either a few hours comfortable, or 
uncomfortable: the air in as little time becoming very damp, 
when it was very dry. Nothing but the active habits of our peo- 
ple prevent their suffering severely from these remarkable chang- 
es. They are perpetually under some strong excitement — re- 
moving, engaging in new enterprizes, and contending about poli- 
tics, religion and law. Yet during our most variable seasons, 
winter and spring, diseases are very frequent, and very violent. — 
And, for the preservation of health, every one should, at these 
times, take particular care to fortify himself against the effect of 
the changes: at least, the aged, the infirm and delicate, cannot 
act with too much caution. In the order in which I have stated 
the sensible qualities of the air, I shall make some remarks on 
each state, with such digressions as may appear to be useful and 
proper on the occasion. And, first, of — 

COLD AIR. 

It is proper to remark here, that cold means nothing but an 
absence of heat; that it is an expression used in compliance with 
custom: that it is a term of relative meaning: that what is cold 
to one man, may feel warm to another; and also to the same man 
at different times; the sensation depending on the condition of 
the atmosphere to which he had been exposed previously. The 
only rule by which we can judge for ourselves, is derived from 
our feelings: and these ought much more to be attended to, in the 
accommodation of ourselves to the state of the air, than they ge- 
nerally are. It is an old remark, that ten persons perish from the 



39 

excess of cold, to one from the excess of heat. In hot countries, 
the luxurious change their clothing to suit each part of the dav: 
surely it is more incumbent on us to take more pains to vary the 
covering of our bodies to suit the changes in the seasons. Some 
wear the same clothing during all seasons; forgetting that the 
system, becoming habituated to it, derives but little benefit in 
change of weather. Thus the man who wears one pair of wool- 
len stockings in summer, will as certainly need two pair in the 
winter, as he who wore cotton will require one pair of woollen; 
and so on of all parts of the dress. 

The primary object of clothing is, to retain the heat that is gi- 
ven out from the body: therefore the best non-conductors of heat, 
must afford the best protection against cold weather. Firs, fea- 
thers, wool, and cotton, make the best resistance to the passage 
of heat, and are properly selected for winter clothing; while for 
the opposite reason, silks and thread clothing are the best for the 
summer. 

Having here introduced the subject of dress, a few further re- 
marks may not be amiss. It is to be lamented that it was ever 
made so as to confine the secretions of parts which should be kept 
cool by evaporation of their moisture. The ancient dress of the 
Romans, which is supposed to be that of the modern highlanders 
of Scotland, had an essential advantage over ours; as, like the pet- 
ticoats of women and children, it favours the free ventilation of 
the parts below the waist — exempting them from many of the 
complaints in those parts, arising from the confinement of the 
secretions by our tight clothes. 

But above all, in dressing, it should be remembered, never to 
let the clothes unequally press or tightly bind any one part. — 
Such is the effect of compression on the body, that when contin- 
ued, it will cause the absorption of the flesh, and even of the 
bones. It is by some people resorted to, in order to compress the 
skull, to make the feet small and the hands and arms tapering.— 
Under any circumstances, it impedes the circulation of the part, 
and eventuates in more or Jess disease. Many misshapen legs 
owe their distortion to garters below the knee; and many women 
have the misfortune of not being able to suckle their children, 
from the compression of their nipples and breasts in early life. 



40 

It will be useless for me to offer any advice about the forms 
of the exterior dress of the rich, as they will follow the fash- 
ions. However, of the interior I have something very impor- 
tant to urge to females: and I beseech their attention and obser- 
vance, as annually it will save thousands and thousands of them 
from the most painful diseases and premature death, which not 
only afflict them, but, from anxiety and sorrow, hurry to the 
tomb their aged parents. 

A leading object of dress with females is surely to excite ad- 
miration; and it is unquestionably one of the most agreeable dis- 
positions animating the bosom of " Heaven's last best gift to 
man." But it is assuredly too dearly gratified at the expence of 
health, life, and affliction to their friends and protectors: — it is 
worse than folly to obtain it imperfectly by destructive means,, 
when it can be perfectly had by those which are pleasant as well 
as safe. The connection of health and beauty is inseparable; and 
as delicacy in appearance adds to the last, it can be obtained if 
all ladies will dress as many of the elder do, to get rid of rheu- 
matic and other pains; and what most of the women of the world 
and the most beautiful part too, are in the habit of doing: I mean 
wear next to their skin waistcoats and drawers of flannel or 
stocking-net. By being made to fit tight, they will always feei 
comfortably warm, and keep up an equal circulation of the blood 
on the surface of the body; giving to the skin its most beautiful 
hue. I shall make no answer to the preposterous reflection about 
wearing breeches; but will repeat the remark of a most respecta- 
^^v^ble Jjqrily, of Philadelphia — that no woman of proper delicacy, 
" knowing her liability to accidents, would ever be found from 
home without such a Grecian or Turkish dress under her upper 
garments. The safety with which the most dashing and fashion- 
able belles, with such covering on the skin, could venture out at 
mid-night; the exemption from the necessity of rushing to fires, 
f<*& y* /^*jj> fccratchin g, „pjff half their bodies, while the other %e shivering, 
#l**~ ought to induce them to follow the advice, exclusive of the beau- 
ty it would give to their faces. In addition to the general healthy, 
rosy appearance, it would exempt them from those bumps, or 
pimples, disfiguring so many of their foreheads, by exciting an 
action in their lower extremities — as men's clothes do — and 
thereby relieving the determination of that blood to the head. 



41 

-which is the cause of them. Could all parents be prevailed on 
to enforce the observance of this advice by their daughters, it 
would require no foresight to pronounce it would hereafter save 
them many a pound, and many a pang. 

WARMING THE BODY. 

As next of importance, I have to impress on you the manner of 
getting warm after exposure to cold. It is known to most of the 
common people, that when their hands and feet have been very 
cold, they only prevented their aching by a gradual approach to 
fire, after washing them in snow or cold water. Now, although 
our lungs are insensible to cold, or even to the cut of a knife, they 
are far more susceptible of diseased action than any part of the 
body. Hence no one escapes occasional colds, catarrhal affections, 
and millions sink under consumptions. Let all, then, who wish 
to escape such afflictions, imitate the practice of those who un- 
derstand the proper manner of warming their extremities: — let 
them more gradually warm their far more important lungs.— 
When exposed to cold air, the approach to a warm room should 
be very slow: first entering a room without fire, and some time 
after proceeding to one better warmed; taking care not to hold the 
face near or towards the chimney for a considerable time. And 
with equal caution, they should avoid all stimulants, as spirit, 
wines, Sec; as they, acting upon the accumulated powers of the 
system, would eventuate in increasing action to a degree of dis- 
ease. 

The general method of warming our houses, is very improper. 
The warmth from stoves, and in all tight rooms, being confined, 
is necessarily injurious; and large fires in rooms more open, are 
very unpleasant, from the unequal application of heat, although 
they are more healthy. The air from cellars being warm, it 
should be obtained from thence. We ought to adopt the plan 
very common in Europe, and practised in many of the houses of 
our cities; it is to have the air heated by an oven, and conducted 
by pipes where it is wanted in different parts of the house. — 
This conveys a constant supply of fresh air, with an equal, regu- 
lar warmth; and is, moreover, very economical. I have often 
wished some such plan were pursued to warm the poor of 
F 



4& 

our cities: conducting* comfortable fresh air in tubes, according 
to the manner in which water is carried to all parts of our cities, 
from one reservoir. It would tend to lessen the diseases of the 
poor; and never was a truth better ascertained, than that, in doing 
this, the rich would lessen their own chances of being affected by 
the epidemics engendered by the objects of their charity. 

Exposure to extremes of cold is very apt to produce a drowsy 
state, ending in deep sleep and death. It is strongly urged to 
guard against the disposition to slumber, by persevering in mak- 
ing every possible exertion. When one is about to venture out 
in severe weather, the extremities should be rubbed with some 
grease, mixed with charcoal, which would much aid in retaining 
the warmth. A small padding of the size of the soal of the 
foot, stuffed with fine charcoal, will be of great service, and is 
more cleanly than the cork soals worn by some in wet weather. 
It would be well to breathe through a porous body before the 
mouth, as it will retain some of the heat of the air as it passes 
through the lungs, and will impart it to the air which is in- 
spired. The face should always be thickly covered; before the 
eyes a glass could easily be placed for sufficient vision: and, how- 
ever such precautions may now appear, they will be found of im- 
portance in extreme cases, where one is liable to great suffering. 
No part of the body should be left unprotected, as more or less it 
will affect the whole system. The blasts of wind in the North of 
Europe and New England — in situations open to damp places — 
produce death in a manner like that brought on by the extremes 
of hot weather. Under such or similar exposures, surely no pre- 
caution should be neglected; and never, under any circumstan- 
ces, by the aged or delicate. 

The diseases produced among the poor and servants, from 
their general manner of sleeping during the winter season, has 
long excited my attention. Near twenty years ago, I made a 
suggestion on the subject in my work on chemistry, which I have 
successfully carried into operation. That it has not been univer- 
sally adopted, I can only account for from the apparent general 
aversion people have to use the most convenient and simple 
means. It is, to have a box, of suitable length for a grown per- 
son, tightly made, charred or lined within with some coarse cloth; 
to be open at one end or on the top; in which a man could lay, 



43 

defended from cold air as effectually as by the best bedding.— A 
little straw would prove of sufficient softness; and a heated stone 
at the feet would add to the warmth; insuring more comfort in 
one night than is had in many, while dosing and shivering before 
fires, as is the case with the greater part of the slaves. The cost 
would be but a trifle; and, by preventing rheumatism, sore legs 
from the unequal heat of fires, and the common catarrhal affec- 
tions; it would amply repay the master for having them made. 

OF HOT AIR. 

This certainly has a very debilitating effect upon our systems, 
when long exposed to it, during the greatest heat of summer. — 
To reduce it when oppressive in our houses, greater efforts should 
be made than we generally find. Without excluding the air, we 
should carefully darken our rooms, as heat is generated by light; 
wetting the floors and walls is of service, as the evaporation car- 
ries off the heat; and so do wet clothes hung before the windows. 
But the best method I have known, is to obtain the air from a 
cool cellar, or deep hole: and it may be the better insured by a 
large bellows communicating from underneath, and gradually 
blowing the air into the apartment. The air from such places 
will always be found as temperate as that in the same places during 
the winter; so that it always feels to us cool in warm, and warm 
in cool weather. 

But in- such contrivances — indeed, in all changes from heated 
air to that which is cold — we should be careful not to go beyond 
moderate limits: remembering that sudden changes from hot to 
cold are almost as bad as from cold to heated places. The hasty- 
passage from very warm to cold rooms, in winter, is often ex- 
ceedingly hurtful, and should be made as gradual as possible. 

OF DRY AIR. 

We know but little of its effects. Art has not yet been able 
effectually to extract all moisture from it. But in the deserts of 
Arabia, where the wind passes over immense plains of sand, con- 
stituting what is called the siracco; it is probably deprived 
of all water, and in consequence produces instant death when 



44 

breathed. The head-ache arising from the heat of stoves, in 
some measure is probably produced from the want of moisture; as 
it is lessened by keeping basins of water on or near them, to eva- 
porate: and during our very dry and hot seasons, the salutary ef- 
fects of throwing water on the floor may, in part, arise from the 
water itself, as well as from the coldness its evaporation produces. 

OF DAMP AIR. 

Of the pernicious effects of damp air, but little doubt can be 
entertained. In all rainy seasons, people are most unhealthy. — 
We know that damp air carries off heat much more rapidly than 
dry air: and we all feel its effects, more or less, every wet day, by 
the dry, unpleasant sensation in the hands and the greater fretful- 
ness of disposition than generally shewn. It is during its preva- 
lence that suicide is most frequently committed, particularly in 
England. 

Wet seasons are more healthy in towns than country; as the 
reflection of heat from the walls expedites the evaporation of the 
water. The most healthy part of a house at such times, is the 
upper stories; the comparative dryness of the air being shewn by 
the greater quickness with which wet clothes will become dry 
above than below. It is better to have no trees or shrubs about 
a house, as they retain moisture. The benefit of shade had bet- 
ter be derived from artificial means — as plank or canvass. 

I have before remarked that it is the changes in the air which 
excite our diseases. The air during the summer months, is gene- 
rally very dry in the day, and at night so overloaded with mois- 
ture that it falls in the shape of dew. Our systems during sleep 
are most liable to be affected. Damp air expedites the passage of 
heat from our bqdiesj and a current of damp air passing over the 
neck, is very apt to produce that painful affection called the wry 
neck. Dr. Lind remarks, that on the coast of Malabar, persons 
who sleep exposed to a current of damp air, are almost univer- 
sally affected with a general palsy. With these striking facts, 
need I dwell on the exceedingly unhealthy practice of sleeping 
with windows open, exposed to night air? — a practice, the source 
of three-fourths of all our summer and fall complaints. In almost 
every instance of bilious fever I haye attended, the persons were ii* 



45 

the habit of sleeping with their windows open. I have personally 
known several Captains of ships, who have sailed to the ports of 
the East and West Indies, as well as to our southern cities. — 
These have assured me, that they forced their men to sleep in the 
narrow room below the decks, and in consequence preserved them 
in health; while adjoining ships, not observing the precaution, 
lost most of their sailors. Reason and experience, then, call upon 
you to sleep, in warm weather, with closed windows. Sufficient 
air can be had through doors and chimneys: and however you 
may have been habituated to the night air, in a little time its 
exclusion will be no inconvenience to your feelings. 

Houses exposed to occasional winds from ponds, marshes, or 
any water course, are very generally unhealthy: and during such 
winds, the doors and windows opening towards them should be 
kept closed. No doubt the putrefaction of stagnant water may 
have some destructive tendency. — But then we know this cannot 
be great; because during the prevalence of malignant yellow fever, 
the air, however infected, cannot carry the contagion more than 
a few yards. There is not the shadow of a doubt on my mind, 
that the great source of the summer and fall diseases, is the mois- 
ture of the air. Let me entreat you, then, to guard against it, as 
you would the most fatal poisons. That some escape unhurt 
from exposure to it, is no more an argument that it is not perni- 
cious, than that it is not dangerous to be under water half an 
hour, because some have recovered after having been so circum- 
stanced. 

Some of the very destructive effects of night air may be account- 
ed for, by supposing that the dew in falling unites with the vari- 
ous particles, or effluvia, which had ascended and volatilized dur* 
ing the day, and carries them to our lungs. But be this idea 
right or wrong, let me entreat you again and again — do not 
sleep breathing a night air: especially in towns and unhealthy 
seasons. Sleep in the highest and driest rooms of your dwellings. 

The facility with which moisture favours the escape of warmth 
or heat, furnishes a strong reason to observe the precaution so 
often given by the old, and neglected by the young: — avoid rooms 
newly plastered, or washed; damp clothes for the person or bed; 
and when exposed to rains, let the change of apparel be as expe- 
ditious as possible. 



■ 



46 



COMPOSITION OF AIR. 

Next to the sensible qualities of our air, we have to notice its 
composition and corruption. I have remarked that it is made of 
four ingredients: that is, of water or vapour, varying in quantity; 
next, of an air called fixed air, or carbonic acid, of which one hun- 
dred parts of our atmosphere contain only from one to two parts; 
then of vital air, called oxygen, which exists in near one-fourth, 
or about twenty-four parts in the hundred; and the remainder of 
the air forming the base of nitre, which therefore is called nitro- 
gen air. It is only the vital air which supports fire and life; but 
for our respiration, the presence of the two other airs is necessary, 
to dilute or weaken the activity of the vital or oxygen air. 

OF FIXED AIR. 

The excess of the first air mentioned, fixed or carbonic acid 
gas, is a frequent source of disease and death. It is heavier than 
our atmospheric air, and is in large quantities in nature united to 
other bodies, from whence it is thrown off. It is formed by the 
burning of charcoal, during the fermenting of porter, beer, cider, 
and such sparkling drinks. It is often met with in the bottom of 
tombs, mines, vaults, caverns, wells, &x. United to lime, it forms 
chalk, limestone, and oyster shells; and when they are burnt to 
make quick-lime, they give it out: while burning, it is dangerous 
to stay near them. The presence of this air may be detected by 
its putting out any burning body introduced into it, and making 
lime-water of a white colour. The frequency of accidents oc- 
curring from this air, renders it necessary that all deep, suspected 
places should be examined before entered, and should be freely 
ventilated; all tight rooms where charcoal has been burnt, and 
close cellars where liquors have been working or fermenting, 
should be particularly ventilated before entered. 

OF VITAL AIR. 

It is proper again to impress on your minds, that it is only the 
vital air, making twenty-four parts in the hundred, that supports 



47 

fire and life. This being an undisputed fact, it must be obvious to 
the slightest observer that it must be very unhealthy to breathe 
over and over the same air or that from others. As soon as the 
vital partis consumed, death comes on, as from drowning or ex- 
posure to fixed air. Free ventilation is the only corrective; and 
hence the excess of folly in assembling in crowded rooms not ven- 
tilated. But the error in breathing an air deprived of much of 
its vital part, is not all the evil on such occasions which you have 
to encounter. The air takes up the filthy secretions of the skin, 
the offensive matter of the mouth, the mucus of the nose; and, in 
breathing it, this nastiness is swallowed and deposited in our 
spittle, whence it is carried to our stomachs; there producing 
disease. You would be much displeased if one were to give you 
the washings of his hands to drink; yet it is very questionable 
if it would be half as filthy as this breathing of the corrupted air 
escaping from all parts of the bodies of others. I hope these re- 
flections will tend to lessen the resort to crowded assemblies, at 
least when they are not very clean and freely ventilated. There 
should be a hole in the centre of the ceiling of every room, to let 
out the heated and consequently ascending air, at the same time 
that a plentiful supply of that which is pure is admitted from 
below. 

The continued breathing of foul air, operates on the body like 
a slow poison, or any powerful stimulus. It corrupts the whole 
system — preparing it for the worst fevers, for the most irregu- 
lar and unnatural disorders, the foulest ulcers, and early death, 
This is exemplified in the lamentable fact of the frequent pre- 
mature death of young physicians brought up in hospitals — 
for years inhaling the effluvia constantly arising from them. In 
like manner, such effects are remarkable among the inhabitants 
of all filthy houses, cellars, &c. In short, a man can no more en- 
counter their effects on the lungs with impunity, than he can the 
continued use of corrupted food or drink, of tobacco or any other 
active stimulus. 

Hence the excessive fatality among- children brought up in 
crowded schools, or manufacturing establishments. — Hence the 
fatality among those negroes crowded together in ships, and in 
the cabins of some parts of our southern country. Were our 
lungs as sensible of the want of pure air, as our mouths are of 



48 

water; the cry for the first, would infinitely exceed that for the 
other: because its importance is far greater for our existence- 
Let me entreat you, therefore, as you regard health and long life, 
take as great pains to secure a constant supply of pure air, as you 
would pure drink or food. I will add, that many masters of 
negroes would much promote their interest, in the preservation 
of their negroes, by paying greater attention to the purity of the 
air they breathe, which of course depends on the dimensions and 
cleanliness of their cabins. 

INFLAMMABLE AIR. 

There is another kind of air unfit for breathing, which is fre- 
quently formed in coal mines, and is given out from some caves 
and springs. This burns with a flame like a candle, and is some- 
times differently composed. It is dispersed by free ventilation.— 
Sometimes it suddenly takes fire, \*hen it burns with such rapidi- 
ty, as to produce an explosion. Fire, at the end of a long pole, 
should be applied to the place where the presence of this air is 
suspected, and its burning will shew whether it be inflammable 
air. In England, this kind of air proved very destructive in the 
coal mines, until Mr. Davy discovered a lamp to expedite its 
removal; which ought to be procured for the deep coal mines of 
this country. 

INFECTIOUS AIR. 

Atmospheric air, besides the ascertainable irregularities in its 
perceptible qualities, which have been mentioned, becomes im- 
pregnated with invisible matter, called contagion or infection — 
such as excites the small pox, measles, chicken pox, hooping 
cough, Sec. The nature of the substances exciting these diseases 
is unknown, and their existence is only inferred from the effects 
produced on living animals. No advances have been made in 
destroying these contagions; but not so with that matter in the 
air which produces our malignant fevers in various shapes, from 
the plague and yellow to low and nervous fevers, under all their 
varying forms of jail, hospital, ship fever, &c. 



49 

The first and most impoi ta it corrective of the matter produc- 
ing the epidemical or the contagious diseases of this climate, is 
full ventilation. Too much in favour of it and cleanliness cannot 
be said. The wealthy people in the large cities of the East, where 
the most dreadful diseases prevail, retire in perfect safety to the 
upper parts of their dwellings, where the effluvia cannot ascend 
without free mixture with atmospheric air. Near twenty years 
ago, I strongly urged such of our citizens as remained in our 
cities during the prevalence of contagious epidemics, to imitate 
the example, and reside in the upper part of their houses. By a 
late writer on domestic medicine we are told, as a great discove- 
ry, that Dr. Caldwell, of Philadelphia, preserved his son from the 
epidemic of that city, by making him live in the upper part of 
his house. A free exposure to the open wind and air of all goods 
that had been in infected places, could not fail of proving of great 
service. 

Experience has taught that it is folly to expect good from 
large fires, from burning gun-powder, or smelling any of the 
volatile vegetable substances. But the experiments of Doctor 
Rousseau, of Philadelphia, have clearly shewn that the greatest ab- 
sorption takes place in the nose; that therefore it is proper to 
stop the nose, so that the breath cannot pass through it; and also 
we should avoid swallowing the spittle, when exposed to conta- 
gion. 

The most immediate corrective of contagion is found in the 
fumes of nitric acid and a preparation of marine acid. To dis- 
infect rooms and ships, Dr. Smith advises that a quantity of 
nitric be warmed in a glass vessel, on which is to be poured an 
equal quantity of sulphuric acid. When this is done, the fumes 
of nitre acid will ascend in the form of red clouds, which will 
quickly spread around and destroy the contagion. It requires 
about two ounces to a common room. These fumes, in England, 
have succeeded in arresting the jail, hospital, and ship fevers; 
and in the North of Europe, as well as in the Indies, have been 
equally successful. They should always be tried when it is sup- 
posed infection exists: never, however, suffering a reliance on 
them to lessen attention to cleanliness and free ventilation.— 
Guyton de Morveau has used with great success the muriatic 
acid in similar case-s. He adds to an ounce of dried salt, the 
G 



50 

same quantity of sulphuric acid, diluted with half as much wa- 
ter. He prefers, however, to this, three ounces of salt, half an 
ounce of powdered manganese, three ounces of sulphuric acid, 
and one ounce of water, to be mixed in a warmed glass vessel, 
when a more active acid air is disengaged. By this he complete- 
ly corrected the air of churches in France, which were so foul 
from putrefaction that an entrance into them was dangerous. It 
has been used in other countries with the happiest success. But 
great caution should be observed in its use, as Dr. Hartshorne, 
of Philadelphia, found this air injurious to many animals. The 
use of these airs about ships will more effectually correct their 
contagion in a few hours than the longest quarantine has ever 
done. 3 

To prevent the generation of contagion, is of greater impor- 
tance than to correct it when formed. The prolific source of it 
is found in the assemblage of many persons together, especially 
the sick in camps, hospitals, jails, and ships. Where great col- 
lections of men cannot be prevented, cleanliness, free washing the 
body in cold water, free admission of fresh air, as also the use of 
the acid fumes, should be strictly enforced. But the disasters 
arising from the crowds of camps and hospitals, may always be 
prevented. Never since we have had accounts of raising large 
armies, have we failed to hear of the ravages of infectious diseas- 
es. The mingling together of men of such various habits, seems 
incompatible with health. The millions who perished during 
the crusades, ought to have given a useful lesson to the whole 
world on this subject. The many who perished during our revo- 
lution, from this cause, ought at least to have made a lasting- 
impression in our country; it destroyed many more than the 
sword. Soldiers fare better when they live as the Indians, than 
when cooped up in tents. For their tents they ought only to have 
shelter from the rain, with no sides that could interrupt the pas- 
sage of air. Hardships or exposures of this kind, instead of 
weakening, have strengthened many exhausted adventurers. 

But of hospitals, as they are generally established in Europe, 
and in this country, I have scarcely patience to write. A view of 
the injuries they have done mankind, is enough to fill any one 
with indignation at the grossness of the error, first in having them 
erected, and then in not having them demolished. They are 



5L 

monuments of the folly, not the wi c dom— -of the vanity, not the 
humanity, of the founders. Scarcely a year passes over, without 
our hearing of some fatal distemper breaking out and spreading 
among them; destroying indiscriminately the man who has but 
the slightest complaint, even a little sore on his finger, with him 
who has had an amputation of a limb; making every disease as- 
sume one destructive character; and diffusing the foulest conta- 
gion among all the attendants and persons in the neighbourhood. 
To say nothing of experience, it is obvious to common sense that 
a man brought up in an open house, surrounded with his family, 
must there be treated more successfully than if removed to the 
tight wards of a hospital: not one of which did I ever enter, that 
did not smell offensively, notwithstanding all attempts at cleanli- 
ness. Yes; the best place for a sick man is one like that to which 
he had been accustomed; — if he have no home, then he should be 
removed to some house like that in which he had lived. The 
benevolent would do much more good, if, instead of the abomi- 
nable practice of building large houses in populous places, they 
would invest their funds in small plantations near to cities: and 
there erect cheap houses, detached and capable of containing three 
or four sick each. The economy of the plan — the superiority of 
the chances of relief — the exemption of the sick from contagion 
and the cries of the dying, would entitle them to greater rewards, 
than the founders of all the splendid hospitals of London or Paris, 
of Philadelphia or New York. For the misfortune of mankind, 
ostentatious founders have not been satisfied with making such 
preposterous provision for men; but have extended them to lying- 
in women and to children. If the accounts of the horrid and 
shocking fatality amongst the little children crammed into these, 
are not enough to ensure their destruction; it can arise only from 
a hardness of heart, or a no less detestable perversity of spirit. 

Some years since, the poor houses in Virginia were made in 
the way in which I propose for hospitals. They consisted of a 
number of detached cabins, with gardens annexed. The esta- 
blishments resembled little villages; and the tenants of these pla- 
ces enjoyed as healthy, comfortable residence, as in their own 
habitations. Of late years, from some strange spirit of imitation, 
many of these have been abandoned for the substitute of large 
brick buildings, where each poor wretch is pestered with the 



53 

groans, complaints, and stench of each other. Had I the power 
of a Caesar, the wealth of a Crassus, and the eloquence of a Cice- 
ro, they should all be devoted to the destruction of every large 
building for the poor, and to the substitution of accommodations 
like those once prevailing in the glorious pride of the union, the 
« ANCIENT DOMINION." 

OF THE SUN. 

Next to the influence of the air in its various states, I consider 
the effects of the sun on our bodies during the warm season. It 
is very certainly a source of immense disease. We are told in 
the Scripture to go to the ant and learn wisdom; and with equal 
propriety, we may be told to go to the beasts of the field and learn 
prudence. I again repeat, that it is the remarkably sudden chan- 
ges in our atmosphere which destroy our constitutions. This 
being true, could it be possible that after the cool, pleasant state 
of the air during the absence of the sun, we could fail to be affect- 
ed, when, a few hours afterwards, exposed to the penetrating rays 
of this powerful luminary. The wonder is, indeed, that it does 
not destroy every one exposed to them. We see all our domes- 
tic animals, however pressed for hunger, abandoning their pas- 
tures and seeking shelter during the hotest part of the day. The 
greater delicacy of our bodies, demands a more rigid adherance 
to this dictate of instinct and common sense. Not a summer 
passes over, without the occurrence of many deaths and much dis- 
ease from exposure to the sun. It operates almost precisely as 
spirit; exciting violent fever, great heat, and excessive thirst.— 
Like intoxication, when it does not produce that sudden death, 
which the French aptly call " coup de soleil," or blow of the 
sun, it ends in affections of the liver, jaundice, dropsies, and 
all those diseases known to follow habitual intemperance. If all 
would work earlier and later in the summer season, there would 
be no loss felt in resting four or five hours in the hottest part of 
every day. This is far more necessary for the white than black 
man. Sir Humphrey Davy has clearly proved that black colour 
carries off heat more rapidly than any other. Hence he enjoins to 
keep the outside of cooking utensils black instead of polished a? 
some over-nice housekeepers do. It is no doubt on this account 



5S 

that a part of the human species was made black; and not, as is 
ridiculously maintained, as a mark of disgrace put on the inno- 
cent descendants of Cain for the murder of his brother. Their 
skin conducts off the heat, which rarifies and volatilizes their flu- 
ids; increasing the evaporation from the skin and consequent sub- 
sequent coolness. They secrete much less urine than the whites, 
although they drink at least as freely. Reason, then, as well as 
experience, teaches that only the dark coloured should be expos- 
ed to what they so much like— a hot sun. The white man should 
avoid it as a deadly poison. If he will not withdraw from it as I 
have suggested, then let him never go out without an umbrella. 
All can procure them as cheap almost as they please. They will 
find an excellent substitute in extensive rims to their hats, made 
of white stiffened paper. Many are prejudiced against such 
means of shelter, because they think it a mark of effeminacy.— 
This erroneous impression has been derived from British ances- 
tors, the prevalence of mists in their country rendering such 
shelter useless. But God knows many of their gallant soldiers 
have, by the sacrifice of their lives in the Indies, dearly paid for 
this prejudice. In all the South of Europe, scarcely a man is 
seen out of his house during the heat of the clay. They well 
know the certainty with which disease is produced, sooner or 
later, by exposure. In this country, the changes from cold to 
heat being greater, it is more necessary to guard against the sum- 
mer sun, which again and again I warn you, none can long with- 
stand, save the coloured man. 

I conclude this subject by inserting a letter to Dr. Rush, pub- 
lished in 1806; which I believe contains a very important hint 
respecting our cities. If a question could arise respecting the 
utility of shelter, it would be removed by the well known histori- 
cal fact, that after the burning of Rome, in the reign of Nero, the 
streets were built wider, exposing a greater surface to the sun; 
when diseases assumed a far more malignant character. 

UNITED STATES' NAVY-YARD, 

New- York, 1 5th June, 1806. 
Dear Sir: 

You will, I hope, excuse my troubling you at this time with 
suggestions concerning the means of arresting the progress of the 



54< 



fatal epidemics, annually desolating the first cities of our country, 
as there is no person to whom I can communicate them with 
more propriety than to yourself. For what medical luminary 
has so long acted usefully on an extensive scale, by deviating 
from the practices of others; by shewing the citizens the error of 
their notions about yellow fever; the folly of dealing with mea- 
sures of a marvellous kind for preservation, and the advantages 
of pursuing natural means, for securing natural ends? 

Before leaving Virginia, I was firmly persuaded of the truth of 
the doctrines which you taught in the University concerning the 
malignant fever in this country. That it is a disease, the cause 
of which is generated at home, and not imported, is so clearly 
true, that it is admitted and supported by most of the faculty, 
who do not oppose the doctrine with a view to preserve the fa- 
vourable opinions of such wealthy and prejudiced persons as 
employ them: and indeed the doctrine is even rapidly gaining 
ground among all the citizens, The general desire at this time 
is, to discover means, not for avoiding importation, but for pre- 
venting at home the formation of that something, called miasma, 
and causing yellow or malignant fever. In the course of your 
labours, you have strongly recommended the removal of all col- 
lections of vegetable and animal matter disposed to putrefy.— 
You have considered that the miasma, or cause of the fevers, was 
generated during the putrefaction of such substances; and you 
have taught that the removal of these; that the preserving clean 
the places frequented by the people, would secure the cities 
against malignant fever. Unfortunately for the health of the 
citizens, your advice has been but partially followed, and perhaps 
it cannot strictly be put in practice: for it seems almost impossi- 
ble to remove all the putrefying masses from the cities, at least 
while so many persons of careless and filthy habits have so much 
©f their own way. 

To me it appears highly probable, that the continued action of 
the light of the sun has more influence in favouring the genera- 
tion of miasma, than has hitherto been supposed. It has long 
been known, that in the animal and vegetable kingdoms, it pro- 
duces most remarkable effects. But few persons are unacquaint- 
ed with the facts, that the colour of the skins of some animals is 
materially changed by exposure to light; that by the same means, 



55 

white vegetables which have grown in the dark lose their white- 
ness, and have their mildest juices converted into the most ac- 
tive; and that it is in consequence of the strong light within the 
tropics, that so many plants are spices, and are very acrid. — 
Surely these facts are more astonishing, than the production of 
that miasma by light which excites fevers. 

No one will pretend to say that the malignancy of fevers is 
proportionate to putrefaction. It even seems likely that the sim- 
ple putrefaction of bodies, under common circumstances, such as 
the existence of heat and moisture, is not in reality injurious to 
men. In all woods, where heat and moisture abound, we know 
that putrefaction progresses constantly and rapidly; yet persons 
enjoy in them the best health, particularly in this country. Dur- 
ing the unhealthy seasons, in the southern states, it is common, 
in some places, for gentlemen to remove from their towns and 
plantations into the thick woods, where they have houses slightly 
built for their reception: so generally is it known to be safe to 
reside in shaded places! Lands shortly after they are cleared, 
are also found to be healthy, although the putrefaction of animals 
and plants must be immense, from the suddenness of the altera- 
tion. It seems almost unquestionable that it is only after long 
exposure to the rays of the sun, that such a species of putrefac- 
tion takes place, as is characterised by the formation of the very 
active compound, causing the fevers which have lately proved so 
destructive in some parts of this country. 

The theory advanced in my inaugural essay, of which you 
were pleased to express your approbation, led me to form an idea 
of the manner by which light was directly instrumental in creat- 
ing miasma. From the firm conviction of the truth of the posi- 
tion, it was without hesitation that I stated " that the form and 
properties of all compounds were acquired in consequence of the 
exercise of the chemical laws or affinities of substances, in the 
state, condition, or circumstances, in which they were placed"-— 
that of course " any material change of circumstances was fol- 
lowed by a change of the properties of the substances placed in 
them;" and that we were to learn by experience what particular 
circumstances were necessary to favour the production of any 
particular compound. 



56 

From the above considerations, I am led to conclude, that such 
is the peculiar nature of light, when it is strong and long contin- 
ued, that it creates the particular circumstances in which the par- 
ticles of putrefying matter of a certain kind, so combine, as to 
form a compound which acts on men, and excites in them malig- 
nant and yellow fevers. Should it be asked, why this compound* 
called miasma, continues to be formed in the autumn, when cir- 
cumstances are changed by the diminution of light — and what is 
partly necessary also, heat; the answer is, that such is the consti-* 
tution or nature of things, that ferment or chemical change once 
excited in any part of a mass, has a strong tendency to pervade 
gradually the whole of it, as is instanced in fermenting fluids, 
burning materials, and indeed in any body in which an alteration 
is wrought in one part before it is in another. When the light 
has been such, as to create that condition in which miasma is 
formed over any surface; an idea of it can be conveyed by observ- 
ing that "there is a misasmatic state.'* By this it will be under- 
stood that miasma exists: as the circumstances in which miasma 
is formed, cannot continue without the formation of it; and indeed 
the existence of the circumstances can only be ascertained by the 
result, or compound. Now, the way to prevent the formation of 
such an active substance, is to prevent the existence of the cir- 
cumstances adapted for its formation. Inasmuch, therefore, as 
we have the power, it should be exercised in diminishing that 
light favouring the production of deleterious substances where 
people dwell. 

It might also be stated as generally true, that the activity of 
the miasma, formed during putrefaction, is proportionate to the 
intensity of the light in which the bodies putrefy. Hence iu 
countries where the light is strongest, as in Egypt, the miasma 
excites the plague; in the towns of the United States, a less vio- 
lent disease, the yellow fever; and in our counties, only the re- 
mittent and intermittent fevers. 

In order, therefore, to preserve cities from the terrible epidem- 
ics, in addition to your wholesome advice of keeping them clean, 
by which much disagreeable stench will be avoided immediately, 
I would recommend shielding them from the action of the sun as 
well as can be done. Coarse and strong linen made in sheets, 
could easily be extended from the eves of the houses on one side 



57 

of the street, to those of the other. These could be so construct- 
ed, that they might be readily removed in all boisterous weather. 
The expense and trouble would not be comparable to that of pav- 
ing the streets, as it would require but a little addition to the 
awnings commonly over the doors of retail stores. But were the 
expense and trouble ten times as considerable, no man of enter- 
prise and humanity would disgrace himself, by putting such con- 
siderations in competition with saving the lives of thousands.— 
In a conversation on this subject, with which I was favoured, with 
Dr. Miller, he suggested the advantages of having trees of large 
branches, at least in wide streets, where they would not impede 
the extinguishment of fires. These certainly must prove of great 
service; not, however, as formerly supposed, by absorbing the 
miasma, but by preventing the light from favouring its produc- 
tion. Nothing can be more certain, than that some very good 
effects would be immediately produced, if the cities were shaded, 
at least in some manner more than they now are. The numer- 
ous deaths arising, as every one knows, from simple exposure to 
the sun, and the burning heats created by the reflection of light 
from the walls, would be avoided; while the labourers would do 
much more work, as well as the citizens in general feel much 
more comfortable. These advantages appear sufficient to justify 
the adoption of my plan, independently of the fair prospect of 
preventing yellow fever. This prospect, however, inclines me to 
wish most ardently for the practice; for I believe it will prove 
successful. Measures less plausible, one would suppose, deserve 
a trial, for the restoration of that happy state of things, when the 
citizens will not annually be forced away from the scenes of busi- 
ness; or compelled to see such numbers prematurely consigned 
to their resting places. To imitate you, in quickening such a 
restoration, is one among the warmest wishes of, 

Dear Sir, 

Your friend and servant, 

THOMAS EWELL. 

From the influence of the sun upon our soils, of moisture or 
some hidden causes, it is astonishing what changes are made in 
our atmosphere, although they cannot be detected by any chemi- 
cal test. The fact is known to thousands, though many disre* 
H 



58 

gard it, and pay dearly for their neglect. You will do well to re- 
member, never during* the warm seasons to descend from elevated 
parts of the country, to low lands, or on the water courses; for in 
ninety-nine cases out of an hundred, fevers are the consequence. 
For like reasons, in warm weather, removals ought never to 
be made to our lime-stone and low countries of the west. — 
While travelling, it is true that persons are not apt to be affect- 
ed; but when that excitement ceases by locating ourselves, the air 
fully operates, and the system has to undergo what is called a 
seasoning, often proving fatal. This is avoided by removing for 
residence, only when cold weather commences. A fatal mis- 
take is often committed by persons visiting and returning from 
our watering places over the mountains, too early. In many in- 
stances, I have known all who have done so, affected on their re- 
turn with bilious fever; while the other parts of the family 
remaining home, entirely escaped. The high tone of the sys- 
tem at such places, fits them for fever on returning: hence it 
should never take place until cold weather, or should be followed 
by continued travelling, with greater attention to guard against 
the sun, night air, and all irregularities, and care should be taken 
to sleep in the most elevated parts of buildings. 

Although I had determined that the above should conclude 
the observations on the effects of the sun, I am tempted to add 
more, from the late deaths which I have heard of, in consequence 
of exposure to its rays. Many, and some of my acquaintance- 
large, robust, able-bodied men, bidding fair- for enjoying the 
longest life — have suddenly sunk under its operation. A great 
clamour we find raised against a man bringing on himself the 
diseases of intemperance; but no notice is taken of an equally 
pernicious practice of self-destruction, by exposure to the almost 
broiling heat of a summer's day. Would to Heaven, I could make 
every one whose life is worth preserving, guard against it with as 
much care as his fears would impel him to shun the supposed 
raging fires of the place of the departed spirits of the bad. No 
drenching in torrents of rain, no ducking in water at any season 
of the year, is half so destructive to the present life and future 
health of a man, as the darkening, scortching, burning, blistering 
rays of our summer's sun. 



59 



DIET. 



There are but few subjects which have more occupied the atten- 
tion of mankind, than the investigation of what is healthy or un- 
healthy for the stomach. And it is probable that there is nothing 
about which so great a diversity of opinion exists — every one fan- 
cying that the article best agreeing with himself, is the best. — 
Indeed, after an acquaintance with the natural history of man, — 
finding him occasionally living on nothing but meats or vegeta- 
bles; on locusts, or on the insects of rotten wood; on putrid fish, 
and on the most disgusting vermin: finding him living on the 
mildest food and drinks; then on the strongest spices and liquids, 
taking daily as much red pepper, spirit, and tobacco, as many 
would suppose enough to kill a dozen horses; — one is tempted to 
quit the subject, in despair of ever throwing light upon it,-— 
But, notwithstanding the mass of contradictory statements, there 
are a few well ascertained facts — very important to be known and 
remembered. 

1 . Although it be possible to exist under the most extraordinary 
circumstances of depravity of habit, and corruption of diet; the 
purest health and longest life are to be obtained by adhering to the 
most simple dictates of nature, and selecting for sustenance the 
soundest articles from the vegetable and animal kingdoms. The 
teeth of a man shew that they were designed to chew meat and 
vegetables alike; and experience proves that a mixture in food is 
most conducive to health. 

2. Nevertheless, it is by a series of the most decided experi- 
ments unquestionably ascertained, that a stomach accustomed to 
the digestion of vegetables exclusively, will not digest animal 
matter; and the reverse when accustomed only to the latter: un- 
less it be very gradually habituated to it. The first change pro- 
duces a little disorder; but by degrees, on the continuance of 
the change, the digestive powers become reconciled to the alte- 
ration in _diet. Nature appears wisely to have provided for 
this peculiarity of the stomach, by a very astonishing gradation 
from one to the other kingdom: so that in their extremes it is im- 
possible to draw lines of distinction. With, no doubt, a similar 
view, in the order of vegetation, each successive fruit of the sea- 



60 

son very slowly, and at first partially arrives to perfection: so that 
the stomach by degrees gets reconciled to its digestion. Briefly 
as I have represented this subject, it is well worthy of your con- 
stant recollection. It should impress on you — at least all the 
young and delicate- — the importance of making every change in 
diet very gradually; never at first eating much of any new article 
of food. When anxious to follow any particular regimen, take 
but little on the first occasion, very little more on the next, and so 
on, until the habit is fully established. Inattention to this, is the 
reason why so many people are sick at the stomach on eating 
freely of fish in the spring, when first in season; and have such 
violent affections of their stomach and bowels after taking large 
quantities of any new fruit. 

3. After eating, rest is indispensably necessary for proper di- 
gestion. This is an important fact. It is fully proved by giving 
to any two similar animals, under the same circumstances, the 
same quantity of similar food: Let one of them be kept in mo- 
tion, the other at rest, for a few hours; then open their stomachs, 
and you will find that the one kept in exercise will have the food 
very little changed; but the one at rest will have far progressed 
in digestion. Hence it follows, that men ought to keep quiet af- 
ter eating, for the same reason that they prescribe it for their 
horses after heartily feeding: for the food undigested in the sto- 
mach acts as any irritating matter would do, and brings on all, 
a variety of diseases equal to those of a foundered horse. Not- 
withstanding the importance of rest after taking food, strong ob- 
jections are made to eating suppers. To this I have to observe, 
that, where the object alone is to yield most nourishment to the 
body, from a given quantity of food, suppers or sleep after eating 
is proper: But where, from inaction or over-eating in the day, 
the system is already too full of blood, it is equally evident, sup- 
pers and sleep are very improper, as proved by their being fre- 
quently followed by disturbed rest, frightful dreams, and all the 
varieties of what is called the night-mare. 

4. Repeated and long continued experiments have clearly es- 
tablished this most important fact — that a given quantity of food, 
well boiled in water, is greatly more nourishing than the same 
articles separately taken. This has been fully proved by the ex- 
periments of Count Rumford. Thus, if a man will have a few 



61 

ounces of meat well boiled, with vegetables, making soup, it will 
yield to his body double the support which the articles would 
without boiling. The healthie'st people in the world, the French, 
live chiefly on soups, and so do most of the Europeans, excepting 
the British, of whom it has been said, as of Americans, that they 
use their stomachs as other people do their pots, for the mixture 
of the ingredients of their diet. As, in our country, the poor and 
the slaves cannot always be provided with an abundance of meat; 
and as, indeed, the eating of the quantities of meat they wish 
would be pernicious, it would greatly add to their comfort and be 
contributory to their health, if their occasional allowances of meat 
were boiled with vegetables into soup. Against this article there 
is a too common prejudice — because it is badly made. If the 
meat were cut up in small pieces, and boiled to rags, as it is 
termed, the whole mess would partake of its flavour, and the dis* 
like to it would soon cease. The few mouths full of meat now 
gulped down, pretty much in the manner of dogs, would, proper- 
ly blended, furnish all their mouths with a very agreeable and 
more nutritious diet. It will be proper also for me to state, for 
your better understanding this subject, that the direct or imme- 
diate parts of animals which yield us nutritious matter, are chief- 
ly, 1. Gelatin, or animal jelly, found most in the skin, mem- 
branes, Sec. 2. Albumen, or a substance like the white of an egg, 
most found in that part of the blood remaining fluid, when it is 
allowed to rest and coagulate. 3. Fibrina, chiefly found in the 
coagulating part of the blood, and the flesh. 4. Oils, found more 
or less in all parts of the solids of animals. Of the vegetable 
kingdom, the direct or immediate parts yielding nourishment, 
are — fecula or starch, gluten, gum, oil, and acids. Although no 
doubt other parts of our food yield sustenance; we can in general 
form a sufficiently accurate opinion of the value of an article of 
diet by the quantities of the above parts found in it, and not mix- 
ed with noxious matter. My object for mentioning them is, to 
shew the great waste that is commonly committed in families, by 
throwing away substances containing these essential ingredients. 
What reason can there be for neglecting to use the blood let out; 
which is of the same nature of that retained in the slaughtered 
animal? And why preserve and cleanse parts of the intestines, 



62 

when all are made alike? The waste of bones is no less remark- 
able: They are made chiefly of oil and jelly, not excepting those 
of the fish; and when pounded and long boiled, they yield as nu- 
tritious soup as the flesh: their being salted, does not diminish 
their value for such use; — nor does the salting of any meat, when 
it is properly boiled, lessen the propriety of making it into soup. 
The same may be urged of all the plants of our gardens; of ail 
articles yielding any of the direct parts of vegetables, enumer- 
ated as nourishing. All our seed and nuts, containing an oil; all 
the gums of our orchard trees, so like gum-arabic — a valuable 
article of diet among the Arabs; the mucilage of the elm bark 
of many plants remarkable for their mucilaginous nature; of wa- 
ter-mellon, quince, and such like seeds, afford as healthy and 
sound support, when boiled, as any articles in common use. The 
careful preservation of such substances, should be attended to by 
all who may be exposed to scarcity, as with but little effort on 
the part of the cook, they may be converted into palatable and 
good soup. 

5, Our bodies have been termed a bundle of habits, perpetually 
tending to go through the excitement one day which they did the 
day before. Hence we desire to eat at the same hour every day. 
The desire to do this, is not so immediately called for on account 
of the want of additional matter for our bodies, as it is on account 
of the accustomed action. It matters not much what times we 
habituate ourselves to eat; excepting that it is material to the 
young and to the old to eat very frequently. But when the habit 
is formed, it should always be attended to; as the suffering in sen- 
sation and health of the body, may from neglect be very conside- 
rable. The stomach requires its distension and consequent ex- 
citement, which is by sympathy communicated to all parts of the 
body. I mention this as introductory to the fact, that death from 
starvation is not from the want of blood, but from the want of this 
action. This is shewn by the fact, that a man when starved to 
death, has as much blood in his body at last as at first. A man 
with a fever taking no food and daily evacuated for weeks, shall 
have his system still full of blood: bears and other animals, 
being very fat when going to their winter quarters or state of 
hibernation; although much reduced in hulk, come out with as* 



68 

much blood as when they entered. Now all this arises from the 
power of the system to convert the immense quantities of fat 
formed in every part, into blood. These facts are stated as a rea- 
son for recommending a very important means of lessening the 
horrors of starvation during sieges, shipwrecks, and other expo- 
sures, under circumstances of deprivation forcing men to devour 
each other and even parts of their own bodies.— It is to suck their 
own blood, as we do on receiving a slight flesh wound, or to have 
it drawn from the veins and made into soup, to which charcoal, 
or any bulky *matter not of a prejudicial nature, might be added. 
To us with a plenty to eat, this may appear disgusting enough. 
But to those suffering the overwhelming pains of hunger, such 
food would yield a delicious repast; prolonging life in a bearable 
state, for weeks longer than it could be done without such a 
substitute. It should also be remembered, that instead of the im- 
mediate death of the animals that may be left for food, most sup- 
port would be derived by taking their blood. Persons who have 
been suffering from starvation, on receiving food, should never be 
allowed to eat much at first — and the little they eat, should be of 
the least stimulating kind. When they^ do otherwise, the food 
acting on the accumulated powers of the stomach, produces too 
much action, and, in consequence, disease and death; just as when 
we are exposed to excessive cold, our bodies are destroyed by too 
sudden an approach to heat. 

It has taken much of the time and attention of many observers, 
to ascertain the truth of the facts I have stated on the subject of 
diet. Their importance should not be valued the less, because 
that I have so partially represented them. They form the 
basis or ground-work upon which any one may fashion his diet 
in the best manner, adapting it to his own particular constitutionr 
They show the folly of some of our capricious gentry, who all at 
once make great changes in their food — in some instances, aban- 
doning all animal matter at once, and living entirely on vegeta- 
bles. This is as bad as the practice of some of our western peo- 
ple, who live almost exclusively on meat; substituting that which 
is dry to eat as bread. In fact, nine out of ten eat too much flesh; 
and this is the reason their minds are so turbulent, and bodies so 
inflammatory: being always ready, the one for a fight, the other 
for a fever. From the mildness of the Hindoos, who live alto- 



64 

gether on vegetables, we may rationally calculate that the high 
action or tone of the systems of our carnivorous brethren will be 
lessened by a diminution of their animal diet, 

DRINKS. 

» 

In all ages, man has sought and found some article of drink,, 
calculated to stimulate his body and exhilirate his spirits. The 
universality of the desire for such beverage, as well as the success 
of the pursuit after it, furnish sufficient evidence of its conformity 
to nature, notwithstanding the abuses which have followed its 
use. But few sources of greater benefit could be found, had there 
have been an inviolable mandate attached to all liquids — that 
they should only be drank to allay thirst; to rouse the sinking 
powers of the body, or to fortify it against the irregularities or 
inclemencies of the seasons. Of our exhilirating drinks, it is ve- 
ry certain that those of the fermented kind are much the most 
salutary; — they generally contain fixed air, and always other in- 
gredients, besides the stimulating part, which are found to act 
something like a tonic. Spirituous liquors should always be di- 
luted, and that freely, before they are drank. The addition of 
sugar and acid to them, tend to lessen their inflammatory effects 
on the system. Of those which are the best, a great variety of 
opinions are entertained. Brandies are considered as least detri- 
mental — but these must be from the grape: for, of all the perni- 
cious, destructive liquors of the kind, ever drank, apple brandy 
is decidedly the most quickly fatal. 

When the body is under high action, with great sense of heat, 
the applying any thing very cold to that all-important and asso- 
ciated receptacle, the stomach, is but little less than downright 
insanity. Cold drinks, in such a state of the body, are annually 
the fruitful source of innumerable lingering disorders, and fre- 
quently of sudden deaths. From the last of June till the near 
approach of fall, thousands sink from drinking cold water. The 
friends of those who so suddenly die, seem to forget the event 
as expeditiously as it occurred. Hence there seems no diminution 
of the practice of drinking copiously when heated. I have known 
three men at one pump to die in a few minutes, from taking 
cold water: and there is scarcely a county in the country, where 



65 

deaths are not produced by copious draughts every harvest. — • 
Let me impress upon you, that large quantities of cold water 
generally increase, instead of abating thirst. The water should 
be but moderately cool, and the mouth well washed with it, as 
also the hands and face; and then some should be swallowed very 
slowly, which prolongs the pleasure and prevents the danger. 
The addition of any thing sour, as a drop or two of oil of vitriol^ 
a little cream of tartar, vinegar, or sour apples, will aid in reliev- 
ing thirst, much more effectually than spirit. By eating any 
sour vegetable, or a little bread and water, the same effect will 
be produced, better than by any quantity of water. It has, in- 
deed, a very singular appearance to see a man take the utmost 
pains to prevent his heated horse from drinking freely of cold 
water, while, on the same day, he will himself drink much more 
dangerously. 

Purity of water is very essential for the preservation of health, 
Its impurities frequently disorder the bowels. — Even the lime 
contained in lime-stone water, I have known to produce fatal 
affections of the stomach and bowels. The carelessness in drink- 
ing water without examining it, has been attended with swallowing 
leeches and other worms, which have proved destructive. When- 
ever men assemble together, as in towns, the water always be- 
comes unpalatable, from the sinking of the filth to the streams be- 
low. Near grave yards, it contains much salt-petre, formed dur- 
ing the putrefaction in the graves. It is well that we have 
ready means of correcting the bad qualities of water, and it would 
be better if they were more generally employed. In the first 
place, water taken from the rivers or streams adjoining towns, 
on placing buckets of it in deep holes or wells, speedily becomes 
as cool as the coolest from such places, and is always pure. — 
Next, impure water put in a barrel on an end, with a little straw 
in its bottom, and half a bushel of coarsely powdered charcoal 
over it, may be drawn off freed from its impurities, at least those 
which are not of a saline nature. 

CLEANLINESS. 

Cleanliness of the skin and mouth, is the next subject to whicji 
I have to request your attention. It is well worthy of more 
I 






66 

consideration from many of the high, as well as low vulgar, than 
it generally receives. The neglect of it, is as much to be depre- 
cated on account of the disgust it creates in those with whom 
the filthy come in contact, as on account of their own health. — 
It is really a vexatious hardship to have stuffed down ones throat 
the nasty exhalations of others, because of their laziness; having 
familiarized themselves to it so fully, that they fancy their stench 
is agreeable. But really many men of sense consider cleanliness 
of person and habits as intimately connected with virtue. Count 
Rumford remarks: " With what care and attention do the feather- 
ed race wash themselves, and put their plumage in order; and 
how perfectly neat, clean and elegant, do they always appear. — 
Among the beasts of the field, those which are the most cleanly 
are generally the most gay and cheerful, or are distinguished by 
a certain air of tranquility and contentment. So great is the 
effect of cleanliness upon man, that it extends even to his moral 
character. Virtue never dwelt long with filth; nor do I believe 
there ever was a person scrupulously attentive to cleanliness who 
was a consummate villain." 

The anointment of the bodv with perfumes to suppress its 
offensive secretions, is a very vulgar and very pernicious prac- 
tice. It is seldom that it does more than very partially suppress 
the effluvia, and that but for a short time; it often does injury, by 
stimulating the skin to diseased action; and it never fails to sug- 
gest to others, that the contrivance is resorted to for the suppres- 
sion of stronger fumes. As I positively assure you, that I am 
acquainted with superior means of correcting such smells, — -means 
which do no possible injury, never fail of success, and essentially 
promote health, — you ought certainly to abandon the use of all 
such perfumed compounds, and give the prescription a full and 
fair trial. 

You ought to be apprised, that it is extremely prejudicial for 
the secretions of the various parts of the body to remain on 
them. The matter adhering, acts on them somewhat as infec- 
tious matter — causing the secretion of more of the kind. The 
secretion adhering to the surface excludes the air, and stimulates 
the parts underneath, which the more rapidly secrete — in some 
cases, particularly with fat persons, to such a degree, as to ren- 
der the atmosphere around them excessively disgusting. The 



67 

remedy for such a state, is the same as that for prevention. It is 
not to apply any thing to the part; but to remove the matter 
from the surface, in the best possible manner, so as to allow the 
contact of cool air, and the insensible evaporation to go on. 

The best means of removing filth from the surface of the 
body, consists in the use of an article excessively cheap — one of 
God's greatest blessings to the human family. It does far more 
than dissolve, cleanse, and purify every part: it prevents and cures 
several of your serious complaints. Considering the vast impor- 
tance of this invaluable article and how often it has escaped notice; 
I am at a loss how to introduce its name. In order to make a 
deeper impression, I wish I could rouse all your faculties at the 
development — that I could extort from you a solemn resolve, 
that it shall be treasured in your remembrance, and daily used.-— 
You need not smile at this pomposity, in introducing the name of 
the universal cleanser: foi if you had never known it, and could 
henceforth be prevailed on to give it the fullest trial, you would 
do homage to its powers more extravagantly than I could speak 
of them. It is hot and cold water, freely applied to every part.— ~ 
Doctor Sangrado never extolled it half so much as it ought to 
have been, when supported by " soaking and elbow exertion." 

The most effectual means of washing the whole body, is to 
daily immerse it for a few minutes, in warm water, at the same 
time rubbing it with a coarse hair brush, to take off the scales 
and filth of the skin. This use of the bath will have a most 
powerful effect indeed, in prolonging your lives, and exempting 
you from disease. I cannot say too much in favour of the clean- 
ly, healthy, invigorating practice. 

An idea of the vast importance of washing the whole skin of 
the body in a bath, may be formed by adverting to the effects of 
it among the Romans. Physicians were of a respectable order in 
the community, until bathing became general. The free use of 
the bath prevented so many disorders, causing such incon- 
siderable demand for doctors, that barbers performed their ordi- 
nary duties. 

In like manner, the standing of the medical faculty was reduced 
in France, after the general introduction of the bath. The French 
are particularly partial to free washing; and, in consequence, sel- 
dom think of a doctor, excepting for the fashionable occasion of 



68 

an accouchmeni. An American physician who visited Paris for 
the purpose of improvement in his profession, assured me that he 
had often endeavoured, in vain, to smell the odours with which 
we are so frequently assailed in this country — sometimes among 
persons in elevated stations. 

The experience of those in our own country, who make a daily 
Use of the bath, is just as impressive. They are not subject, in 
general, to half of the disorders afflicting those who suffer their 
skins to remain besmeared and covered with the exudation from 
the pores. The females of the southern states, who frequently 
bathe during the summer, derive great benefit from the operation. 
The advantages derived from visiting the water places, unques- 
tionably depend more on the washing of the skin, than on any 
medical qualities in the water. 

Indeed, I think after viewing this subject in the fairest light, 
on account of humanity and pleasure, every person ought to be 
compelled to bathe daily in warm water. The means of warming 
water are in the hands of every one, without incurring the ex- 
pense of additional fire. If a small excavation be made in the 
funnel of chimneys, a pot may be fixed, around which the smoke 
passing, will give a sufficiency of its heat to make a large quanti- 
ty of water of the requisite warmth. But the plan giving least 
trouble, is that of heating water to scald hogs in the country. — 
It is to put stones and old irons into the fire, and when heated, to 
throw them to the bottom of an open mouthed barrel of water.— 
Two or three of such bodies can always be kept, without incon- 
venience, in every fire-place, and will suffice, in a few minutes, to 
make the water of the proper heat. As soon as this is done, 
they can be removed, and the person sitting in the barrel will 
have a most pleasant mode of purifying every part. 

AIR BATH. 

Dr. Franklin discovered that our health was considerably pro- 
moted by exposing our persons naked to cold air for a few min- 
utes every morning, and then returning to bed a little while before 
dressing. This exposure to air favours evaporation from the 
skin, and has considerable effect, therefore, in cleansing the body, 
increased by the glow or sense of heat felt on the surface, which 



69 

promotes the evaporation, while it tends to prevent internal dis- 
orders. Much good would result from a general use of this air 
bath. Its refreshing powers are frequently found by a person 
restless at night, and unable to sleep. By getting up and hoisting 
a window to admit fresh air, the superfluous heat is carried off; 
and I have frequently known this exposure to be followed by a 
very speedy and refreshing sleep. 

COLD AND SALT BATH. 

The use of the cold bath every morning could not fail to an- 
swer the purpose of promoting health, more effectually than the 
air bath. Persons generally suppose a great deal of water is ne- 
cessary to be poured on the body; but it is a mistake. The ob- 
ject is to shock the system, so as to rouse action on the surface; 
and a quart of water splashed on the back suddenly, and running 
around the body and down the legs, will answer all the purpose. 
Instead of the ordinary preparations, stand on the hearth, and 
have some one (or ones self can do it,) turn over on the back 
the water in a basin or cup. This is all that is necessary. When 
desirable to use the sea bath, you can always have it by adding 
half a pint of salt to half a gallon of water. The salt assists in 
stimulating the skin: and it gives such vigour, and is so cheap, 
that it should be used daily in every family. As I shall fre- 
quently prescribe this mixture, I wish it to be remembered under 
the name of the salt bath. The substitute for general bathing, is 
local washing; and I commence with the feet. 

In some persons the feet are so disgusting, as to be intolerable; 
and persons taking the idea that it is natural^ give themselves no 
trouble about purification, unless it be now and then to make 
them worse, by putting some perfume on them. But there is 
nothing more certain, than that the smell may always be prevent- 
ed by daily washing in soap and water. They should be rubbed 
and scraped hard. It is proper to guard against wearing old 
shoes, as old leather increases the odour. 

Before passing over the subject of the feet, I wish to commu- 
nicate to you a discovery by an old woman, for preventing the 
colds or catarrhs which annoy so many of us. It is, every morn- 
ing before dressing, to dip the feet in a basin of fresh cold water, 



70 

to wipe them immediately, and return them to bed for a little 
while. A glow will be felt, which is a proof of the determination 
of blood to the part; a determination, which will prevent your 
receiving; colds one-tenth as often as you have or otherwise 
might. The practice can do you no possible harm; and I 
entreat you to observe it, because I am positive, that in addition 
to the cleanliness of the practice, it will shield you from many 
attacks, probably even from those that might end in consump- 
tion. 

The smell of the arms is another point to which more attention 
should be paid than generally is. Perfumes do no good here. — 
It is water and soap, and hard scrubbing, that purify this region. 
An idea has been entertained among many, that this is naturally 
in some cases too strong to be relieved by washing. But it is a 
mistake. There is no case in which the arm-pit cannot be made 
perfectly mild in its smell, by daily rubbing with soap and a wet 
cloth. Lime water is a species of lye, and has been preferred by 
many. When the hair under the arm has been allowed to remain 
as it were matted in the secretion of the part, the more persever- 
ance will be necessary. Those who smell so very rank, I would 
advise to cut off the hair in the beginning, so that the daily wash- 
ing may be more effectual in cleansing the skin. I conclude this 
subject with the remark, that, considering the certainty with 
which persons can relieve themselves from this smell in the way 
pointed out, there is some excuse for the frequency with which 
they are condemned for the puffs inhaled from their arms. 

The next subject for which I have to request your attention, is 
the most disagreeable, but it is best to state it plainly at once; it. 
is the smell peculiar to the posteriors and the adjacent parts.—- 
The large quantities of fat in this region and the numerous glands, 
tend to keep up a constant and profuse secretion of strong smell- 
ing matter, especially after walking, the most disgusting that 
comes from our bodies. I have heard some more condemned for 
neglecting to free themselves from this effluvia, than for any other 
negligence. Some really have indulged in it so long, as not only 
to appear partial to it, but to fancy that others must have the 
same relish. I once knew a physician refuse continuing his visits 
to a fat lady of wealth, because of the excessive disgust this smell, 
arising solely from her laziness, gave him. I hope you will pay 



71 

the more attention to what I have to urge for keeping these parts 
clean and inodorous, as truly the means will have a powerful ten- 
dency to establish and preserve your health, since the parts are 
intimately connected with the general system. 

The great secret for cleansing, and exempting these parts from 
disease, — do pray remember it — is to sit night and morning in a 
tub or piggin of cold water, with or without soap; and for four or 
five minutes splash and rub the water around. I feel my want of 
powers to impress the importance of the observance of this prac- 
tice. The prescription should be observed from the oldest to the 
youngest, male and female. The posteriors of most animals are 
naked; so that what is secreted is speedily evaporated, with the 
consequence of their total exemption from disorder. Children 
frequently throwing up their clothes, so as to ventilate themselves 
fully, have but few complaints of these parts, and it is certain 
ours would be more healthy if more exposed to cold air. The 
substitute for this exposure, is cold washing. The matter secre- 
ted around is dissolved, and goes off with the water, leaving the 
air to take off in imperceptible evaporation, what is afterwards 
formed; while the tone of the parts becomes so improved, the 
action of the vessels so lessened by the cold, that the quantity and 
quality of the secretion cease to be subjects of attention. 

If I could but prevail on those of you who can get piggins, and 
all who cannot procure them to go daily at the edge of a brook, 
to sit in cold water for a few minutes, I would render you most 
real service. Indeed, this frequent washing in cold water will 
prevent your having that distressing complaint called the piles, 
as also any kind of boils, fistulas, or inflammations of these parts. 
Another great and important advantage of the practice, is the tak- 
ing away the secretion of the adjoining glands, which is apt to 
become acrid and offensive — thus irritating and exciting the ex- 
ternal sources of sexual feeling. There is indeed no doubt that 
such irritation is the cause of premature desires, prostitution, 
hysterical affections, and diminished growth of the body. All 
animals have their growth diminished by such excitements; and 
therefore parents ought to guard their children against this — as 
well as huging, toying, and amorous talk, which produce the 
like action. The practice of this cold washing at least at night, 
will prove so advantageous, that I feel as if I cannot sufficiently 



« 



urge you — never, never to neglect it. As soon as the habit 
of doing it is acquired, it will prove a source of far greater 
refreshment or pleasurable excitement, than washing the hands 
and face. 

The purification of the mouth and teeth, is one of the most im- 
portant points to which you can attend. To the Scripture, that 
"out of the mouth cometh forth evils", might have been added, 
with equal truth — in it are engendered many. It is very aston- 
ishing how greatly all parts of the body are affected by the mouth. 
You may have witnessed how small a quantity of wine or spirit 
held in it, tends to invigorate the whole system. A disgusting 
mouthful frequently excites vomiting in persons not the most de- 
licate; and diseases of the tongue, gums, and teeth, almost uni- 
versally produce considerable, often dangerous effects in other 
and sometimes the most distant parts of the body. 

This being the case — as most assuredly it is — does it not ap- 
pear strange that so many escape sickness and death, who, neg- 
lecting their mouths, have the most disgusting matter perpetu- 
ally generating between their teeth, and carried down to their sto- 
machs, there acting as a slow poison, in the excitement of innu- 
merable disorders? It is with the utmost pleasure that I am ena- 
bled to say to you, the evils from this source may be prevented 
entirely: that you may all have what all want — a pure, sweet 
breath, as it is called, however defective your teeth, by means con- 
tributive to pleasure. 

After all the researches of doctors, quacks, and ladies, for the 
best dentrifice; after the use for centuries of simples and com- 
pounds, hazarding the destruction of all, and ruining many teeth; 
after all the inventions of tooth-brushes, stiff and soft, and then of 
sponge, the great discovery has at last been made, that the best 
possible application to the teeth and gums, is an article very 
cheap, endangering nothing, purifying the mouth, by bringing 
out the offensive matter formed in it; which important article is 
commonly called warm water ! 

The preservation of the teeth depends most on the purification 
of the mouth. In order to purify the mouth and teeth effectually, 
they must be washed in warm water morning and night, and regu- 
larly after eating. The water should be taken into the mouth, 
the lips held tight, and then freely and strongly agitated by work- 



73 

ing the jaws and tongue, so that the effects shall be felt on the 
gums and the glands, as well as on the teeth. No tooth-brush is 
necessary — the finger answering sufficiently for rubbing; but if 
you will have a tooth-brush, let it be of the softest kind you can 
procure; a piece of sponge tied at the end of a stick, answers very 
well; as does a clean linen rag. Nothing can be more destructive 
to gums and teeth than a stiff hair brush. 

There is but one tooth-powder I would ever consent to be used. 
This is vegetable matter; as crust of bread, or common coal, 
well burnt and reduced to fine powder. Objections have been 
made to it, from the fear of darkening the teeth, which are en- 
tirely groundless; as the teeth are only darkened when their co- 
vering, called enamel, is rubbed away in consequence of the fol- 
ly of using corrosives and hard brushes. Charcoal has a power- 
ful effect in resisting the putrefaction of all the matter between 
the teeth. Those who fancy there are better powders, may be 
allowed to try powdered chalk, soap and water; also, Armenian 
bole and Peruvian bark; but they should be absolutely prohibited 
from the use of acids, salts, or any active article. Remember, 
that the enamel of the teeth once destroyed, can never be restored. 

When the teeth, from long neglect, become incrusted with a 
dark, yellowish looking matter, called tartar, this ought to be 
scraped off with a pen-knife, very slowly. There are little scra- 
pers made for the purpose, answering with more convenience.—- 
Only the parts of the teeth that have on them the tartar, or fo- 
reign substance, ought to be scraped; so that the sound parts 
will not be injured, as they always are, when hard brushes and 
active articles are used to wear off, and to dissolve the incrusta- 
tion. 

In cases where the teeth are " rottening," in order to prevent 
the disagreeable taint they give to the breath, it is best to push 
in them a small particle of charcoal. Where the hollow of the 
tooth is considerable, after putting in a little charcoal, there 
ought to be a small piece of bees wax pressed over it, to remain 
as a plug. The facility with which this plug may be removed is 
a great convenience, as it enables you to take out at pleasure any 
matter which may be formed underneath. 

There are cases where the enamel of the teeth being broken off 
foy some violent operation, (nut cracking) a plug more permanent 
J 



74 ' 

than wax is necessary. In such cases, a dentist should be em- 
ployed to insert a plug of gold to exclude permanently from the 
root of the tooth, the air, saliva, and whatever else may be put in 
the mouth, 

But where the teeth are actually decaying; and in cases where 
defective roots of teeth, called stumps, remain in the sockets, ex- 
cepting with pregnant women; they should be immediately ex- 
tracted; more especially in those cases where the health is deli- 
cate. The neglect to do it, has been the cause of the disease and 
death of millions. I before hinted at the connection between the 
mouth and the general system. You perceive that children, teeth- 
ing, have a great variety of disorders in consequence of the irri- 
tation in their mouths. This connection or sympathy between 
the mouth and other parts will appear the more striking, from the 
facts respecting the transplanting of teeth, which was formerly 
done frequently. Those who underwent the operation of trans- 
planting were very often subject to diseases almost precisely like 
those of the venereal nature. They had enlargements of the 
bones, deep ulcerations, and were cured, for a short while, by 
mercury, which induced the belief that they were of the venereal 
kind. This led to the greatest caution in the selection of the per- 
son to supply the teeth; nevertheless, the same consequences en- 
sued. At last it was discovered, that the cause of the complaints 
was the irritation kept up in the sockets of the teeth, by the fo- 
reign tooth inserted; which, of course, led to the abandonment of 
the practice, and substitution of artificial teeth resting on the 
gums. Now, what I wish you to remember constantly is, that 
decayed teeth in the gums produce precisely the same effects: 
enlargement of bones, ulcerations, bowel complaints, and many 
other disorders, depending on the particular sympathies of each 
person. 

But few physicians ever think of this subject. It was very 
early and very forcibly impressed on my mind by two or three ca- 
ses clearly establishing its importance. In one instance, an el- 
derly gentleman, repeatedly salivated for a supposed venereal 
taint, sent for me, and on my prescription, " take out every de- 
fective tooth," he laughed heartily; at length I prevailed on him 
to follow the advice, and a perfect recovery made him a warm 
convert to extracting rotten teeth. Deafness has been often pror 



73 

duced by decayed teeth in the sockets, and often relieved by their 
extraction. 

Whether you comprehend the reasoning on the subject, or not, 
you will save yourselves from many tormenting affections by fol- 
lowing the advice. Indeed, I am so positive of the great advan- 
tages which will result from it, that you will be fully paid for the 
trouble of a year's study, if you will but remember to compel 
your doctors to extract your decayed teeth, at least whenever you 
have any serious complaint. It will at all events be of essential 
service in lessening the irritation in your systems, inclining them 
to fever. It will have a great tendency to prevent the adjoining 
teeth from decaying; especially if, in addition, you will keep the 
mouth well cleansed with warm water, particularly after eating 
and sleeping, without injuring the gums. 

I conclude this subject by remarking, that if I have urged 
enough to induce you to sit daily in a tub of cold water, or to 
bathe in the easy and economical manner suggested: and to keep 
your mouths clean by frequently washing them in warm water, 
at least after eating, and to have your decayed stumps of teeth 
extracted; you will derive ample remuneration — far greater than 
the trouble you have had in reading my observations. Pray give 
my recommendations a fair trial: and on finding the advantages I 
have stated, offer the advice to all the uninformed, or heedless, 
coming under your notice* 

EVACUATIONS. ^ 

These are from the bowels, kidneys, and skin; the first of which 
appears most material to attend to. In different persons the dis- 
charge from the bowels is very irregular; occurring with some, 
more than once a day, and with others, not once a week. Some- 
times these irregularities pass off without injury; but in general, 
they ought to be corrected and made regular. All the material 
operations of the body had best be from habitual exercise, as 
they are then less liable to affect the system; and there is none of 
more importance than those of the bowels. The neglect of a little 
precaution affords instances of great effects following trifling cau- 
ses. A considerable variety of diseases is brought on by retaining 
the contents of the bowels. The retention, from the bulk of the mat- 



76 

ter alone, excites inflammation of the surrounding parts, often 
marked by piles and boils near the fundament: next, the excre- 
ment ferments, and generates large quantities of foul, irritating 
matter, which passing up and down in the bowels, stimulates to 
diseased action as any other fumes introduced would certainly do. 
You must readily admit this, if you will refer to the difference in 
quality and quantity of the wind escaping from the bowels, when 
the contents have been long retained or speedily discharged. In 
the latter case, they are comparatively inoffensive; while in the 
other, they are shockingly offensive. Many cases of colic and 
indigestion arise from this cause; frequently dysentery, and other 
diseases in parts sympathising with those affected. 

In order to evacuate the bowels regularly, the celebrated Mr. 
Locke recommended daily visiting the necessary, at the same 
hour- — never going sooner or later, unless impelled by disease. 
You have observed the remarkable regularity in the returns of 
appetite, thirst, sleep, agues, bleedings, and the like periodical 
excitements. The human system is perpetually inclined to do 
one day what it did the day before. Hence, with the utmost cer- 
tainty, you may calculate on an exemption from all the complaints 
of costiveness if you will take the pains to go regularly to the ne- 
cessary at the same hour every day; unless impelled by disease, 
never going sooner or later. In the beginning, attention and effort 
will be necessary to establish the habit: but when established, let 
nothing prevent your attending to it. In obstinate cases, you 
should use the "sailor's remedy:" this is the introduction up the 
fundament of a piece of hard soap, shaped as the little finger. It 
should be pushed up the fundament, and held there until the eva- 
cuation comes on. A similar cut piece of wood, with a soaped 
or greased rag around it, or the finger when oiled, will equally 
answer. By persevering in such attempts, the habit will soon be 
fixed, and it will remind you of the approach of the hour without 
fail. Again I beseech you to persevere in the attempt, even 
though disappointed in the beginning. The advantages result- 
ing, would compensate far greater labour. If you fully knew the 
enormous quantities of physic swallowed for correcting costive- 
ness, the variety of diseases brought on by retaining the decom- 
posing contents of the bowels; you would not require again to be 
told of this certain remedy. I will add, the efforts had better be 



77 

made in a necessary open at bottom, for the admission of cool am 
On the principle of Dr. Franklin's air bath, before mentioned, this 
will evaporate the moisture of the parts; producing coldness, and 
rousing them to new and vigorous action. For women, as well 
as men, this would be infinitely more salutary; as it is more 
cleanly than the lazy and disgusting habit of using pots in hou- 
ses. But on such occasions it may be best, as it will be more use- 
ful, to obey the command given to the Israelites in Deuteronomy, 
(chap. 23. v. 13.) "and thou shalt have a paddle upon thy weapon; 
and it shall be when thou wilt ease thyself abroad, thou shalt dig 
therewith, and shalt turn back and cover that which cometh from 
thee." By doing this at the side of some cultivated plant, its 
growth would be expedited and we avoid the disagreeable smell. 
When the evacution is made, it is certainly most proper to wash 
the fundament in its protruding state, as it thereby will be effec- 
tually cleansed, which it seems very difficult to do by common 
wiping. In selecting something to wipe with, irritating articles, 
as the weed called "ass smart," the leaves of the poison oak, Sec. 
should not be used; as they have been known to produce mortifi- 
cation of the fundament. Persons who are weak, or in danger of 
having very large evacuations; should never remain long in mak> 
ing the discharge, or do it in an erect posture, as it may end in 
fainting and death. 

URINE. 

The contents of the bladder, like those of the bowels, are sub- 
ject to great variations in quality and quantity. The secretion 
depends not only on the state of the kidneys, where it is formed; 
but the time of its retention in the bladder. Notwithstanding the 
great attention which the urine appears to have excited in all ages, 
but very little is known respecting the causes of its variations. — 
But we know that its long retention in the bladder is very perni- 
cious. It distends this vessel when retained, and undergoes a spe- 
cies of putrefaction sometimes very offensive, and from both cau- 
ses is apt to create irritation and inflammation; also, it deposites 
a sediment, not unfrequently forming a base for the stone or gra- 
vel. The inclination to void it, ought always to be followed by 
its indulgence— particularly with women: as its retention by them, 



7B 

is apt to cause displacement of the womb, especially in early preg- 
nancy. It is very apt to excite dreaming when retained in the 
night; and with elder persons, it disturbs sleep, which renders it 
essential that they like children should frequently void it. A sud- 
den application of cold air or water to the skin, tends to excite an 
inclination to urinate. When the slightest impediment to its eva- 
cuation exists, there should be an early application for profes- 
sional assistance, as the most fatal consequences sometimes fol- 
low from what appears very inconsiderable. 

PERSPIRATION. 

The skin is much connected with the kidneys and stomach. — 
The perspiration is a discharge perpetually going on, either in a 
sensible or insensible state. Like the urine, it varies in quality 
and quantity — from invisible vapours to large drops; from mild, 
inodorous vapours, to very offensive sweat. The state of the sto- 
mach has great influence upon this secretion; as we frequently 
find the slightest sickness followed by profuse perspiration. Like 
the urine, this discharge affords no grounds for forming accurate 
opinions respecting diseases. — But we know that for health, it 
should be moderate and regular. Its sudden suppression by 
changes from heat to cold, is a source of great mischief. Expo- 
sures, therefore, to currents of air, while perspiring, should be 
carefully avoided, as the evaporation of the moisture increases 
coldness. This is the cause of the numerous affections of the 
lungs — as colds, pleurisies, and consumptions. Whenever the 
perspiration becomes offensive, the warm bath, with salt or soap, 
ought immediately to be tried. Insensible perspiration is great- 
est when the skin is hotest; and then the bath ought to be rather 
cool — at least, not much warmer than the surrounding air. Per- 
sons subject to irregular perspiration,— that is, at times having 
very little, and at others having it very profuse, — should wear 
flannel next their skin, which will tend at least to regulate its 
evaporation. 



79 



EXERCISE AND REST. 

A proper mixture of these, is as necessary for good health as 
pure food and drink. The circulation of our fluids and the action 
of our solids, may be compared to a mill-race and mill: where the 
water constantly coming, unless vent be given, it backs, increas- 
ing in magnitude, until it bursts and overwhelms the mill. Our 
capacity or power of action is constantly accumulating, unless we 
give vent to it by an expenditure of exertion: and if we do not, 
violent action is sure to burst the natural state of the solids. — 
Health requires a perpetual accumulation and dispersion of the 
animal powers, to be secured only by rest and motion. To con- 
tinue the comparison; when the waters have accumulated in the 
race, a little hoisting of the gate will give vent to a great deal, 
and much will be the increase of motion in the mill. So when 
the power or capacity of the body is accumulated, but little ex- 
citing cause will produce great action. Thus we find when the 
powers of the stomach are accumulated from the want of food, a 
little of it will produce -great motion: thus a man deprived of heat 
pr in a frozen state, will be violently acted on by a very little 
warmth. It is precisely so with the muscular powers of the body: 
their capacity increased or accumulated by rest, must be exhaust- 
ed by motion, or very inconsiderable causes will produce diseased 
action. It is true that the indolent do sometimes apparently es- 
cape; but it should be remembered that our systems are so form- 
ed, that one part often performs the functions of another: and from 
sympathy sometimes takes on the diseased action of another part, 
and thereby exhausts the accumulated capacity or power or excit- 
ability. This always takes place sooner or later; sometimes the 
violent excitement being immediate and in the particular part 
kept idle, while at others it is procrastinated and in some differ- 
ent part of the body. But you may rely up it, that in some shape 
or other, have the expenditure assuredly you will. Nature has 
made our constitutions for it, and with her there can be no tri- 
fling. Her laws are not to be violated with impunity: atonement 
she will have for every irregularity: your physicians may post- 
pone, but your bodies must make the payment at last. 



80 

But surely no such general remarks can be requisite to con- 
vince you of the great importance of exercise. You daily per- 
ceive the difference between the meats of animals brought up in 
a state of nature and those raised in pens and artificially fattened: 
the one is possessed of a delicate flavour; the other is a mass of 
almost tasteless, oily matter. It is just so with the active and 
lazy man: the system of the one is kept invigorated — able to re- 
sist disease; that of the other seems so loosely held together, that 
like a rotten fabric, the slightest shake speedily shatters and de- 
stroys it. 

The proper place for exercise is in the open air. It then most 
tends to invigorate and renovate the whole body. Hence the 
strength of women who exercise in the open fields, is superior to 
that of the most industrious confined to their houses. But to 
those who cannot leave their habitations, particularly the old, I 
would recommend the daily use of the swing; and to all, the freest 
use of a stiff brush for the hardest friction of the skin. 

But after having said so much about exercise, it is proper to 
observgjjpfiat when too great, it prevents sleep: and that sleep — 
rest, perfect rest — is equally necessary. To the person who 
expects too much work from his man, I have to state that he must 
have time to accumulate the exhausted capacities of his body. — 
From seven to nine hours for sleep, quiet and in comfort, should 
be allowed to every labourer. To allow him less, or to make 
him work immoderately, is to make him in constitution "old 
in youth" — blasted in his prime. One of the best wishes I 
could make for my country is, that there might be among them 
as remarkable an equality in their bodily exertions, as there is in 
their political privileges. 

It is much to the credit of the great mass of our slave-owners, 
that they have very generally improved in the treatment of their 
negroes; giving them far better accommodations, and requiring 
of them less extraordinary labour than our forefathers. But still 
there are many who would better promote their own interests, by 
bestowing more attention on them-— as constantly providing for 
them as they do for their favourite horses, sound food, a com- 
fortable bed, and undisturbed rest, and requiring daily but mode- 
rate labour. 



81 

I will conclude this subject with offering the precaution, that 
persons laying down to sleep, should not only avoid all damp 
places, but old piles of stone, brush, and ground floors, where 
various worms, especially the many-footed kind, exist. Under 
such exposures during sleep, worms have crept up the nose and 
into the fundament; sometimes producing the most excruciating 
tortures during the remainder of life. 

THE PASSIONS. 

The intimate connection between the mind and body has beeri 
long remarked. It is scarcely possible to affect the one without 
the other. In the ordinary occupations of each, this does not 
appear so obvious; but it is sufficiently shewn when there is vio- 
lent excitement of the passions. Their moderate exercise unques- 
tionably tends to animate the body— to equalize all its actions— 
to invigorate all its powers. But their immoderate indulgence, 
scarcely ever fails to produce disease— often to an alarming ex- 
tent — sometimes sudden death. The passions are to our systems 
what streams are to valleys: so long as they gently move, they are 
subordinate to the most important purposes; but when raised be- 
yond due limits, all bounds are burst asunder, and ruin to mind and 
body marks the progress. 

ANGER. 

If the body could complain of its wrongs, the baneful effects of 
this passion would be the first subject of expostulation. It ope- 
rates on the system sometimes like an electric shock; producing 
a sudden rupture of the blood vessels of the brain, and conse- 
quently death: at others, raving madness, convulsions, palsies, and 
continued fevers. Indeed, during its excitement, there is always 
considerable fever. If persons on their own account, will not re- 
frain from yielding to this passion, their associates ought studi- 
ously to avoid provoking them; feeling pity for the infirmity. — 
Washing the head in cold water, and drinking a glass of the same, 
will tend to allay the fit; but if not successful, bleeding, and a lit- 
tle tartar to produce sickness at stomach, will soon divert the 
thoughts to another subject. 
K 



82 



FEAR. 

This has often produced insanity and death. Its first effect is 
generally a loss of the contractile powers of the fundament and 
bladder: hence their contents are apt to come out. Parents can- 
not be too careful to prevent the attendants on their children from 
frightening them. If it do not produce immediate disease, it will 
probably make them cowards for life. In sickness, all fears 
should be avoided: as they tend to bring on the evils dreaded — 
especially among women who are pregnant. There is no exage- 
ration in the statement, that thousands are annually hurried to the 
grave, by fearing the fatal termination of their disorders. Hence 
the extreme folly of alarming the sick — of ever giving them to 
understand the hopelessness of their case — or of telling them that 
they are about to die. Nature has for wise purposes, concealed 
from us the time of our dissolution; and it is unpardonable in at- 
tendants to attempt counteracting her ways, by offering their fal^ 
lacious opinions, and, most frequently, unfounded predictions; 
often preferring the gratification of their vanity in the fulfilment, 
to its diappointment in the recovery of the patient. 

GRIEF. 

We cannot avoid feeling this, on meeting with misfortunes.— 
But the subjects of it should have impressed on their minds, that 
an indulgence in it, is not only unavailing, but inconsistent with 
health, reason, and resignation to the will of God. After its first 
ebulitions shall have subsided, the utmost efforts should be made 
to force the mind to different exercise: the best is that which rou- 
ses the energies of the body at the same time. Bathing in cold 
water, travelling on hard going horses and in carriages over bad 
roads, new scenes, or hard work, will speedily dispel the settled 
gloom. 

LOVE. 

The most agreeable and animating of the passions, comes in 
for its share of mischievous effects; producing distempered minds 
and emaciated bodies. The objects of love should never be se- 



83 

lected among" relations-: as marriage among them, tends to enfee- 
ble the offspring. There is certainly an observable degeneracy in 
all families frequently intermarrying. We find it so with most ani- 
mals long confined to each other on our plantations; so that it is 
no inconsiderable object to cross the breed. And so it should 
always be with men and women, as it generally is in this country 
and England. I have no doubt but that it is owing to the mix- 
ture of foreign blood — a compound of almost all nations, that we 
find such specimens of superior genius; eclipsing in display, 
though not in diligent research, all other countries. 

All under the influence of love, on meeting with disappoint- 
ment, should refrain from despondency or thinking of the object. 
They should recollect how many there are, so like the one belov- 
ed. An earnest pursuit of business — new scenes — change of com- 
panions—boisterous encounters, afford reasonable antidotes to its 
baneful influence. But I should suppose a sovereign remedy 
Would be found in an introduction behind the curtains — an expo- 
sition of circumstances, analogous to some of Swift's singular 
verses:-^-in short, an impressive discovery of the infirmities of 
human nature. 



JOY. 



When in excess, this has frequently terminated in a very joy- 
less way — destroying instantly the life of the party. Indeed, I be- 
lieve it is much less easy to encounter very good than very bad 
news. It is useless for me to detail cases illustrative of its fatal 
effects; as every reader must be familiar with some examples — at 
least in ancient, if not in modern story. When the person is 
weak, or the news of a very important nature, it ought to be im- 
parted by very slow degrees: carefully keeping up suspense — cu- 
riosity — hope, stronger and stronger still — 'till the system is ful- 
ly prepared for confirmation. 

RELIGION. 

This has a most powerful effect on the mind and body: and, 
properly exercised, it produces serenity — tranquility in the one, 
industry and energy in the other. Beyond proper boundaries, it 



84 

eventuates in fanaticism or insanity in the one; convulsions or 
indolence in the other. Strange as it may seem, it is a well es- 
tablished fact that many of the most pious, innocent persons — 
especially females — are very prone to derangement. Their minds 
become inflamed with fears, oppressed by forebodings, or destroy- 
ed by despair. The impassioned denunciations of some of the 
professors of religion, so engross the intellect, that scarcely a 
thought remains of the mild, the gentle, loving, cheering reli- 
gion, as taught in the words and by the example of Christ him- 
self. The alarming, hell-denouncing vociferations of the mouth- 
ing votaries of the gospel, are taken for the inspirations of 
divinity; — all reason, sometimes even sensation departs, and 
violent death occasionally closes the scene. It is well to remark 
in this place the strong propensity we have for imitation. It is 
so great, that sometimes in the extensive wards of a hospital, 
when one patient is brought in with convulsions, although the 
complaints of all the others in the room are of a different nature, 
each one in a little time has become affected with the same kind 
of convulsions. So, in an assembly of noisy enthusiasts in reli- 
gion, a fit excited in one has often, from like sympathy, been 
communicated to hundreds — particularly to all of a weak, ner- 
vous, delicate cast. This the exciters call conversion to Chris- 
tianity; although very generally attended by a loss of all sense, 
a state of stupor, or violent screaming, and tossing of the ex- 
tremities. Persons whose nerves are in a weak state, cannot be 
too cautious in visiting such places. I have to add, that it is the 
extreme of folly, not to say cruelty, in the friends of persons ill, 
and probably about to die, to suffer their last moments to be 
shortened and embittered by the interference of these bellowing, 
awakening exhorters. They do no good; but excite a frantic 
feeling like that raised when people are running roaring out fire! 
fire! The last periods of life should surely be spent exclusively 
in the contemplation of the attributes of God: his goodness — his 
love-^and his limitless mercy. Instead of making religion a 
bug-bear to frighten, we should always remember — 



u > 

(t s 



Tis this that makes our morning- brig-lit; 
Tis this that gilds the horror of the night.' 



85 



INTEMPERANCE. 



The abuse or excessive use of the good things of this world, 
falls heavily indeed upon our bodies. There is scarcely one ir- 
regularity of which we are guilty, without our having to suffer 
in proportion to its extent. Could we always have presence of 
mind enough to count the cost, before the commitment, it would 
spare us much suffering; many of what we may call bills against 
future health for present riot. 

Although the term intemperate is generally applied to drunk- 
ards, it is equally applicable to eaters, in over quantity as well as 
high quality; to the too free lovers of the sex, as well as of the 
spices. Whether from diet or drinks, teas or tobacco, women 
or wine — you may rely upon it as an incontrovertible fact, that 
any universal excitement in the body naturally and necessarily 
tends to exhaust its powers, and shorten its duration. 

The gormandizer is the most selfish of all men: he is con- 
stantly thinking of his maw, destined to " that good hour" of 
filling. But, like the fancied Anaconda of the East, he is sure to 
perish, to putrefy, from his own excesses. Apoplexy, palsy, dis- 
order of his digestive powers, or gout in the stomach, generally 
makes his body, at an early age, good food for consumption, in- 
stead of a voracious consumer. If accustomed to a full disten- 
tion of the stomach, he should substitute for his diet such bulky 
articles as bread, potatoes, or rice, in preference to those which 
are more nourishing. 

Persons accustomed to the use of large quantities of tea or to- 
bacco, find great difficulty in refraining from them. Their sys- 
tems suffer as much when deprived of them, as those deprived of 
their accustomed spirit; moreover, when the constitution is de- 
bilitated or undermined by them, it is more difficult to restore it: 
Hence the great care persons should take to avoid the use of such 
stimulating articles. The young ought never to take them, as 
they naturally arrest the growth of the body. This is so well 
understood, that puppies are often highly stimulated to prevent 
their becoming large dogs. Our spices, mustard, pepper, ginger, 
horse-radish, and indeed ail pungent articles, should be kept 



86 

from the young, as they more or less injure the tone of the 
stomach and vigour of the body. 

Habitual inebriation invariably ends in some kind of affection 
of the liver, and indirectly affects the stomach and the brain 
through it, and also the skin, and often terminates in dropsy, di- 
arrhoea, &c. It makes one old in youth, as to body; and as to 
intellect, a baby in age. Its destructive effects on the mind con- 
stitute its most dreadful tendency; as it renders idiotical, intel- 
lects of the greatest strength. From at first expanding the heart, 
opening its avenues to every generous impulse; it centres in all 
that is meanly selfish and lowly brutal. 

It was the opinion of the late Doctor Rush, that persons guilty 
of frequent intoxication, should at once abandon the use of all sti- 
mulating drinks: "touch not, taste not, handle not," he urged on 
every sot. I have repeated his recommendations to many — urg- 
ing the propriety of doing as the Doctor advised. The conse- 
quence, I have long believed, is that it has been instrumental in 
hurrying the death of several elderly persons who suddenly and 
entirely refrained. Experience has proved to me that Dr. Rush's 
advice should be followed strictly by all young and middle-aged 
persons. Their constitutions can accommodate themselves to the 
sudden change. — But not so with those who have passed the prime 
of life. To perpetuate their existence, I would strongly recommend 
the gradual abandonment — the substitution of new drinks, of opi- 
um, of spices, or of any essential oil which will stimulate the sto- 
mach. If they have not resolution to keep within the bounds of 
temperance, some friend, not so brutal as perpetually to provoke 
them to irregularities, should undertake to preserve and portion 
their doses in proper quantities. The sober ought to remem- 
ber that the propensity of the drunkard, is an affection of the 
mind — the diseases of which are generally more under the con- 
trol of gentle than harsh means. However depraved the object, 
lenity, tenderness, and respect in ones conduct to him, will ope- 
rate far more powerfully than ^rudeness and rebuke. To cherish 
a decent respect for ones self, leads to the cultivation of a regard 
for the opinions of mankind: while an opposite practice leads to 
an opposite course; to feelings regardless of ones self—of the 
world — and all that is concerned in iV. 



87 

Intemperance in sexual intercourse is no less destructive: it im- 
pairs the mind and body when too early, too violently, or too long 
indulged. In early life, it certainly impedes the growth of the 
body; indulged in excess, it produces fatuity and baldness. In 
age, it hurries to the grave, as is frequently instanced in the spee- 
dy death of old men marrying young women. Between the two 
there is a striking conformity or resemblance in ridiculous folly; 
but in their bodies, a greater dissimilarity no where is to be found. 
In the East Indies, where the veneral passion is very early and 
very freely indulged, there is a great paucity of mind and imbe- 
cility of body. The passion is nearly extinct at the age of thir- 
ty; and it is so mortifying to the delinquents, that the universal 
entreaty to European physicians on going among them, is for 
something to restore its vigour. Similar effects follow from si- 
milar conduct every where: Hence our worn-out rakes make 
np in the ribaldry of their tongues, what they have lost in the 
animal function. Hence an old man — one of sixty—who has 
preserved his power, is better for procreation, than a debauchee of 
thirty. Well would it be for the enjoyment or happiness of all, 
if it could constantly |?e borne in mind, that 

" Health consists in temperance alone," 

In concluding this part of the subject, I shall offer from second 
hand, the excellent advice of Celsus. " A man who is blessed 
with good health, should confine himself to no rules, either with 
respect to diet or medicine. He aught frequently to diversify his 
manner of living; to be sometimes in town, sometimes in the coun- 
try; to hunt, sail, indulge himself in rest — but more frequently to 
use exercise. He aught to refuse no kind of food that is common- 
ly used; sometimes to eat more — sometimes less; sometimes to 
make one at an entertainment and sometimes to forbear; to make 
rather two meals aday than one; and to eat heartily, provided he 
well digests it. He should be careful in time of health, not to 
destroy by excesses of any kind, that vigour of constitution which 
should support him under sickness/* 



88 



ACCIDENTS, 

From lightning and from carriages, are so very frequent in 
this country, that I deem it of importance to make some re- 
marks upon the subject. With ordinary care, I have no doubt 
that half of them could be prevented. It is the nature of light- 
ning to strike the body nearest to it, and run down its exterior to 
the ground: it is also most apt to follow any current of air. This 
should teach us, as well as the most unquestionable experience 
which has been had of its propriety, always to keep every part of 
our houses shut up during a thunder storm. The chimneys 
should also be close.d, as a current of air is constantly passing 
through them. The inhabitants of the house should be in the 
lowest part — in the centre of the room, and, if convenient, on a 
bed. ■ Thousands of houses have been struck under such circum- 
stances, without injury to the inhabitants. Again, the doors or 
windows should never be opened until the storm is completely 
over. In consequence of opening them too soon, a current of air 
rushes in — carrying the electric fluid, which, within my know- 
ledge, has destroyed more than a dozen persons. When exposed 
to a storm without shelter, persons should avoid any elevated ob- 
ject, as trees or stakes, and lay down on the ground where there 
is least wind passing. 

Of carriages and horses, it is very remarkable, particularly 
among stage-owners, less care is taken to provide those that are 
safe, than vehicles to carry produce. Hence we find the stage 
the place for all the wild horses in the neighbourhood, and the 
frequency with which accidents occur in them. The late Profes- 
sor Wistar of Philadelphia, whose solicitude to instruct his class 
knew no bounds, took considerable pains to impress them, when 
in a carriage whilst the horses are running away, to remain in 
it at the bottom, unless in danger of passing a fatal precipice. — 
That when the carriage is upsetting, the person should coil 
himself as much up in a ball as possible, the knees to the sto- 
mach, the head on them, and the arms entwined around the legs, 
so that the bruise of the fall would be on no projecting part.—- 
The folly of extending the arms to lessen the fall, is shewn by 
the constancy with which they are fractured. Again, in jumping 
out or off from a horse, the jump should be made so as to twist 



89 

the body half round, so that the feet will light in the direction in 
which the horse is running. If this be not done, in all human 
probability the ankle bones will be fractured, as the ankle joint 
has but little motion sideways; and the body having the velocity 
which it received from the horse, the feet being fixed to the 
ground, the tearing of the parts seems almost inevitable. But 
when the feet and face are in the direction of the motion, the 
joints bend or give way, and tne*body falls, rolling somewhat as a 
hoop, thereby not exposing any one part to all the severity of the 
fall. The remembrance of these precautions has more than once 
saved me from broken or dislocated joints. 

It may be well here to add a caution against striking persons 
on the head. Blows sometimes of most trifling appearances 
prove fatal: the parts underneath the skull take on inflammation, 
and the brain is destroyed. I have known a blow on the head 
from a key to cause the death of a boy; and our books of sur- 
gery are full of fatal events from such trifling causes. If the 
blow be severe, a numbness or insensibility is produced, and 
there is but little pain; hence, if the desire be to inflict pain at 
the time, some other more sensible and less vital part should be 
struck. 

Blows to females on the small or bend of the back, should ne- 
ver be given. The bones there are very tender, easily bent, and, 
when bent, often end in the destruction of the life of the poor 
sufferer during her first child-birth; so that the violent bruiser 
becomes accessary to two shocking deaths. 

RECAPITULATION 
Of the Means of preserving Health after Infancy. 



1. Take all the precaution in your power to guard against the 
irregularities of the weather: adapting the clothes to the chang- 
es, especially in extremes of cold; women by all means, in win- 
ter, wearing the tight under-dress of the Turks next to their 
skin, as a sovereign preventive of the colds and consumptions 
which carry off annually thousands of them. 

2. Be very particular in breathing the warm air of a room af- 
ter coming from cold places, as the lungs are affected as violently 
by the heat, as are the extremities of the body when cold. 

L 



90 

3. In hot weather, keep your rooms cool by the exclusion of 
light, and by wetting the floors, hanging up wet cloths at the 
windows, or admitting air from the cool cellars below. 

4. During all sickly seasons, especially in the summer and fall> 
guard against sleeping exposed to night air; as that, probably 
more than any thing else, is the cause of fevers and other dis- 
eases. 

5. Ventilate freely confined places previous to entrance; or, if 
the presence of air not respirable be suspected, first introduce a 
burning candle, which becomes extinguished if the air be unfit for 
breathing. 

6. Avoid breathing the same air too often, or that which comes 
from others; because it loses its vital part, and becomes impreg- 
nated with noxious matter. Hence, sleep in large rooms, with 
but few others in them, and without fires, which equally destroy 
the air. 

7. In sickly seasons, when you cannot change your residence — 
guard against foul or infectious air, by following the practice of 
the people of the East, in living in the highest parts of houses; 
free ventilation and cleanliness; when with the sick ? not breath- 
ing through the nose, or swallowing the spittle; and by purifying 
their rooms with the fumes of the mineral acids. 

8. By preventing the confinement of many sick, poor or pri- 
soners, together in one room, you will prevent the generation of 
that contagious matter which has destroyed so many in camps, 
jails, hospitals, ships, cellars, 8cc. It is incalculable how many 
thousands of the lives of the poor emigrants to this country would 
have been saved on the voyage, by the use of a few ounces of min- 
eral acids, as has been recommended on the subject of purifying 
air. 

9. Avoid exposure to the rays of a hot summer's sun, with the 
same care that the prudent beasts of the field do: their strong ef- 
fects on the system being like ardent spirit, producing either in- 
stant death, inflammatory fever, or disease of the liver, with its 
usual attendants. 

10. Never return from watering places, or mountainous coun- 
tries, to the warmer parts you inhabited, until cold weather has 
commenced; nor should you until then remove to low lands, or to 



91 

any new country, unless you can keep constantly travelling" till 
frost commences. 

11. Let your diet be as simple and plain as possible, and all 
changes in it be gradually made; preferring a mixture of animal 
and vegetable food; and substituting, at least in times of scarcity, 
soups for solids. 

12. Avoid cold drinks when heated, for the same reason that it 
is prescribed to horses; and in selecting drinks, give a preference 
to those which are fermented; never taking spirit undiluted. 

13. Cleanliness of mouth and skin, is constantly to be preserv- 
ed by frequent washing — at least all with defective teeth — and 
all parts of the skin which secrete freely; because the matter on 
them becomes corrupted, corrupting the whole body. 

14. Preserve regularity in the evacuation of the bowels daily, 
and never retain the urine after a desire to void it; because these 
discharges, when retained, are apt to irritate and excite disease: 
and in like manner, pay attention to the discharge from the skin; 
when considerable, having the clothes changed, and avoiding ex- 
posure to a current of air, which, by evaporating the moisture, 
produces great coldness, and the diseases usually arising from 
cold. 

15. Remember that the powers of the body require perpetual 
renovation, as well as expenditure: therefore exercise and rest, in 
proper proportion, are indispensably necessary for health. 

16. Never indulge in violent passions of any kind: their mode- 
rate exercise is certainly necessary for the perfection of the body, 
but their high excitement is destructive to it; they, like every 
other stimulant, require a due regulation from rage to religion. 

17. Recollect that all intemperance in the use of the things of 
this world, " falls heavily indeed upon our bodies,'* acting upon 
them as bills on future health for present riot; that, according to 
the construction of our frames, it amounts to an impossibility 
that it could be otherwise. 

18. Observe the precaution, in thunder storms, to keep in hou- 
ses closely shut up; never approaching doors or windows, until 
they have subsided. And in falling from any vehicle in motion, 
coil up as much as possible, or endeavour to light on the feet in 
the direction in which you are moving; or, in other words, not to 
light sideways, to endanger the dislocation of the ankles. 



9& 

The last advice, though not the least in importance, which I 
have to offer for preserving health, is a great attention to regula- 
rity in all habits. By not observing these, the routine of action 
in the body becomes interrupted, and disease in consequence is 
more apt to enter in its subsequent operations. Hence, other cir- 
cumstances being equal, the most regular, systematic persons ar& 
the most healthy. 



iQ 



jwwrtaa mvt. 



1. PRINCIPLES ON WHICH LIFE IS SUPPORTED.— OF 

SOME OF THE FUNCTIONS OF PARTS OF THE 
BODY.— PRINCIPLES ON WHICH DISEASES ARE 
CURED, AND THEIR PARTICULAR REMEDIES. 

2. DESCRIPTION OF THE OFFICES WOMEN SHOULD 

PERFORM TO EACH OTHER IN CHILDBED:— 
THEIR DISEASES; AND THE DISEASES OF CHIL- 
DREN. 



3, TREATMENT OF COMMON COMPLAINTS. 



DEDICATION. 

To Joseph Hartshorne, M. J), of Philadelphia, Surgeon 
to the Pennsylvania Hospital, 8£c. 

Dear Doctor: 

In inscribing to you the medical part 
of this volume, I have consulted my inclination, instead 
of your wishes. It is the dictate of the respect, regard, 
and gratitude I have for you, which, in plain terms and 
honest truth, is greater than for any medical man I ever 
knew. I. have read many books in the various branches 
of our profession — almost half as many as yourself — but 
from none have I received more instruction than from 
your frank and free communications for more than the 
last twenty years, when I have been with you. Seated 
at a great fountain of medical science, you have been the 
first to observe and to communicate improvements; al- 
ways imparting your knowledge with an unusual liberali- 
ty, correspondent to that with which nature has moulded 
your mind. 

On account of the reputation of the Medical School of 
Philadelphia, as well as the interests of its future stu- 
dents, f. sincerely regret that you were not elected Pro- 
fessor of Surgery, occasioned by one casting vote. It is 
shameful that the teachers of our art should be elected iu 
the University by a set of persons totally ignorant of all 
its principles, and consequently incompetentto make the 
most judicious appointments. The Trustees should have 
had modesty enough to have declined acting in the case; 






96 

to have left it to the decision of our brethren of the facul- 
ty, who would promptly have appointed you; because 
they have long known the superiority of your learning, 
the importance of your improvements, and the extraordi- 
nary success with which you practice surgery and physic. 

May you long live, not only for the happiness of your' 
family, but for those who will sojourn to Philadelphia for 
the benefit of your professional services. 

Your Friend and Fellow-Graduate, 

THOMAS EWELL. 

Georgetown, August, 18&4. 



% 



ADDRESS II. 

Principles of Life; Functions of parts of the Body; 
Principles on which Diseases are cured, and their 
particular Remedies. 

When the principle or spirit, or essence, or what else you may 
choose to term the capacity of existence, is infused or given to 
any matter capable of receiving it, it adapts that matter to a state 
capable of action; and this is called LIFE. But this capacity of 
action would speedily become extinct, unless something acted 
upon it. That which acts upon it may be called the cause of ac- 
tion; or, in common language, a stimulant. Thus the eye has 
the capacity of seeing: but it is not roused or excited to action, 
unless light operates on it, producing vision;— and the same sort 
of remark is applicable to the action of every part of the body.— 
The lungs stimulated by the air, impart new qualities to the 
blood, which stimulates the heart: and this all the blood vessels 
of the body, giving to each its appropriate stimulus. The food 
stimulates the stomach to secrete a juice, called the gastric juice, 
which dissolves the nutritious particles; and this again stimu- 
lates the vessels of the bowels made for its reception; and they, 
being stimulated by it, contract and propel it to the place destin- 
ed for it — to be mixed with the blood, to supply the expenditures 
of our body. Our senses are stimulated by what acts on them: 
these stimulate the brain, which excites thought, which again 
stimulates the brain to further action: thus perpetuating itself 
by action and re-action, which it is to be hoped will go on to 
eternity — forever advancing, though never arriving at perfection. 

I hope this is enough for you to understand the simple doc- 
trine of animal life, as advanced by the celebrated Brown, com- 
M 



m 

prised in the few words: — that life is a forced state, depending on 
the action of stimulants: upon our susceptibility of action, called 
excitability? and that this life, or excitement of our bodies, 
should be in proportion to our excitability, for health to exist.— 
This is a short sketch of the subject, which has produced a great 
revolution in medicine, and will hereafter probably do the same 
in morals. Thus, a man knowing- that his labourer has only a cer- 
tain share of excitability — that when too much exhausted, health 
is destroyed: he would not cause it by imposing too much of the 
stimulus of labour. Thus, if one were conscious that by taking too 
much of the stimulus of spirit, his excitability would be exhaust- 
ed, he would refrain in moderate bounds. Thus, if the indolent 
man were conscious that by inaction his excitability accumulat- 
ed, so that moderate stimulants produced over-excitement, or dis- 
eased action — all necessarily following,-— he would exhaust it by 
exertion in a pleasant manner, rather than have it done by the 
painful excitements of diseased action. 

Those wishing to understand this doctrine, as it ought to be by 
every gentleman, had better consult the writings of Doctors 
Brown and Rush on animal life. I shall have to make a few more 
remarks on the subject presently, when treating of diseases; but 
I hope enough is stated to impart an outline of the subject. 

STRUCTURE OF THE BODY. 

On taking a view of the body, we find it is made of solids and 
fluids. Every solid is found to be made up of tubes or small ves- 
sels, through which the circulation or motion of the fluids takes 
place; so that the two are inseparable. Again, we find each so- 
lid composed of three very distinct, yet, in their smallest state, 
invisible vessels — so woven together as to exceed our imagination, 
much less our art to separate them. These three sets of vessels 
are nevertheless very different in their functions. They are— 

1. The blood vessels, including heart, arteries and veins, by 
which all parts of the body are formed. 

2. The nervous vessels, including the brain and nerves, by 
which all motion or capacity of motion is made. 

3. The absorbent vessels*, by which our food is taken up and 
carried to the blood, and every part of the body perpetually ab~ 



99 

sorbed, or taken up, and carried to the blood vessels for re-manu- 
facture or expulsion. 

Thus these three distinct sets of vessels, yet inseparable, mu- 
tually acting on each other, keep up the perpetual interior mo- 
tions of the body, through the agency of stimulants acting on the 
exteriors; in other words, constituting our excitability, on which 
stimulants act to produce excitement, or the phenomena of life. 

PRINCIPLES UPON WHICH THE PARTS OF THE BODY ARE 

FORMED. 

The principle upon which the various parts of the body are 
formed, has long been a subject of investigation, and very differ- 
ent views of it have been taken. It has been supposed to be the 
result of a kind of straining or filtration of the fluids, leaving the 
parts needed for the particular purpose wanted, while the rest 
passed on to the circulating mass. Again, it has been supposed 
to be the result of a particular action in the small vessels, con- 
verting or modifying the blood into the state or matter wanted. 
I advanced a new theory on the subject; and the following is 
taken from the fifteenth of my Discourses on Chemistry: 

THE ARTERIAL BLOOD. 

The arterial blood being properly formed, a most important 
question arises, concerning the means by which it is converted 
into the parts of the body, and into the secretions. This has 
long occupied the attention of those studying the nature of the 
animal body. The more I have reflected on this subject, the more 
am I convinced that the common modes of accounting for such 
phenomena, are far from being perfect. In my Inaugural Essay, 
I advanced a new theory on the subject, on which the more I re- 
flect, the more does it appear to me to be the true explanation. — 
Of the correctness of this, I am further persuaded by the concur- 
rence of some of the first characters in the country. But a few 
days have elapsed, since I was favoured with a conversation on 
this subject, with the learned Dr. Hosack, an eminent practition- 
er of physic, of New York, and Professor of Botany in Columbia 
College. This gentleman, without any hesitation, assured me 



100 

that he believed the doctrine to be correct, I mention this, with 
a view to induce others to examine it more attentively, that its 
merit or defects may be decidedly ascertained. It may not be 
amiss to extract the following from my essay, from which an idea 
of the theory may be formed: 

When we view the animal machine, we are struck with the ex- 
treme vascularity of all its parts. This is so general and consid- 
erable, that the human body has been emphatically called a u col- 
lection of capillaries." In these capillary vessels, or small tubes, 
the most important operations are performed; for it is in these? 
that the blood is so wonderfully modified, as to be adapted to all 
the exigencies of the system. The most general operation we 
notice, is the conversion of arterial into venous blood. No part 
is exempt from this remarkable process, whereby the properties 
of blood become so materially altered. While we keep in view 
the uniformity and the simplicity of the operations of nature, we 
will account for this phenomenon on common principles. 

It is an undoubted fact, that the form and properties of sub- 
Stances are variable, and depend on the circumstances in which 
they are placed. By experience and observation, we learn what 
changes can be produced, and what is necessary to produce them. 
For example: of water, we find that in a low degree of heat, the 
particles cease to roll on each other, and become so arranged as 
to constitute ice. In a higher degree of heat, another substance, 
the e^g 9 is deprived of its fluidity; 'while the solidity of a metal 
is lost in the same temperature. 

In accounting for such phenomena, we do not call in the agen- 
cy of an intelligent vis vita, or uncommon principle; neither can 
they be referred to one of the agents separately. We are to infer 
that they arise in consequence of the natural tendencies or affini- 
ties of the substances, exercised in consequence of the circum- 
stances created by lessening or augmenting the heat. Let us ex- 
tend this plan of making inferences from facts, to the human 
body. 

But a little experience is necessary to teach us that the arterial 
blood, like most substances, is susceptible of the greatest chang- 
es, and that these changes can be varied with the circumstances 
in which it is placed. For example, in the arteries we see it is of 
a vermillion colour; but, as Sir Isaac Newton long since observ- 



. 



101 

ed, in a particular position it is yellow. We see, also, that it 
loses its fluidity when allowed to rest, or placed in a temperature 
above one hundred and sixty degrees. When allowed to rest, 
the coagulating lymph of the blood unites, and becomes solid.— 
This tendency of the lymph is also seen in the granulations of 
wounds, which being covered with it, readily unite together. — 
The coagulum formed by the union of the iymph, possesses some 
of the characteristics of life. These I presume are acquired in 
consequence of the union, and partial organisation of the lymph, 
effected by the attraction of cohesion. Such causes (as lightning) 
which prevent the coagulation of the blood, operate by changing 
the state necessary for its contraction. 

When the blood is propelled to the small capillary vessels, in 
consequence of fibrous action, (which is the only effect of fibrous 
action we perceive,) the circumstances necessary for its continu- 
ance in the state of arterial blood no longer exist. On arriving 
at the commencement of the veins, it takes on the properties pe- 
culiar to it in that state of parts, by the exercise of its affinities, and 
is thus converted into venous blood. Here we see the agents, 
the solids of the part and the blood, as in the cases first mention- 
ed. As the solids remain unaltered, the effects we should refer 
to the exercise of the natural affinities of the blood in the parts, 
just as we do the various shapes of water, eggs, and all other 
substances, in other circumstances. 

If the above be correct, we are led to look upon the body as a 
laboratory in which the most important operations are perform- 
ed. From the difference in the construction of its parts, we na- 
turally conclude that various compounds are formed. And ac- 
cordingly we find that different processes go on, and that com- 
pounds different from venous are formed from arterial blood. — 
These are the secretions so familiar to us all. 

Physiologists, in accounting for the secretions since the rejec- 
tion of the explanation on principles of mechanical filtration, have 
referred them to chemical changes wrought by the actions of the 
secreting vessels. The only effect of the action of a collection 
of vessels forming a gland, or secreting body, that I can perceive, 
is to propel or convey the blood through it; and indeed it is to 
me incomprehensible, how the motions of simple tubes or ves- 
sels could possibly produce changes in the fluid. I shall, there- 



fore, waive the consideration of the conjecture, and proceed to 
account for the phenomena on the simple principles suggested 
above. 

Although we be unable to detect the particulars in which one 
secreting vessel differs in its structure from another, yet on the 
slightest attention we can perceive a very material difference.— 
We can readily discover that the very delicate hand of nature 
has made an astonishing modification of even the most minute 
vessels. From the various structure of all the glands, the blood 
when conveyed in them, assumes in each, in consequence of ex- 
ercising the affinities peculiar to it in the respective states, the 
necessary forms and properties. Mr. Home observes, that im- 
mediately on leaving the vessels, the secretions are fluid, and ac- 
quire their consistence shortly after. When the new properties 
are acquired, the ducts or other tubes convey them to the parts 
for which they were formed. It is thus, I presume, by the exer- 
cise of chemical laws, or affinities regulated by states, depending on 
the mechanism of parts, that the successive supplies of all the secre- 
tions are created from the blood. 

If this explanation be admitted, the vague conjectures of phy- 
siologists relative to secretion, must be laid aside. In place of 
them we will have the plain facts, that nature was accurate and 
wise when she so made the solids of animals, that the fluids ac- 
quire in them by their own tendencies the necessary form and 
properties. Nor does she here demonstrate more forcibly a deli- 
cacy and wisdom in operating, than in the structure of her mas- 
ter-piece, the eye. 

Our theory has something more than simplicity to render it 
plausible. It will enable us to explain several phenomena which 
have excited astonishment. The resemblance of all venous blood, 
coming from parts secreting very different fluids, can no longer 
appear mysterious. 

The formation of an oily matter after death resembling sper- 
maceti, and, also, other secretions, are common occurrences. — 
Fourcroy, by a particular process, was enabled to form bile from 
the blood of an ox, which has been erroneously supposed to be a 
proof of its - being formed in the blood. It must readily appear 
from the invariable laws of matter, that whether the necessary 
circumstances for the formation of a compound exist in the body- 






103 

1>efore or after death, or elsewhere are created by art, that such a 
compound would be necessarily created when the constituent 
parts are present. Hence this leads us to expect, that from the 
improvement of our arts, all the secretions may be formed by us 
at some future day. 

There is a fact familiar to most of us, which tends to prove the 
correctness of these statements. This is the support which one 
animal receives from the secretions of another. It is true, that 
some of these are more nutricious than others. This in a great 
measure must proceed from a strong cohesion resisting the lesser 
tendency to assume the form necessary for nourishment. The 
secretions having a tendency to decomposition, afford a generous 
support, and fat and milk are among the most remarkable.— 
When these are swallowed, they are dissolved by the gastric juice, 
conveyed to vessels where they assume the form of chyle, and 
then pass on to the blood, and assume on the same principles its 
properties. Here we have, almost to demonstration, the same 
particles of matter in the shapes of a secretion, then chyle, then 
blood, in which last form it had existed. 

There is a system of vessels whose office to the body seems 
the reverse of that of the secretories. This is formed by the ab- 
sorbing vessels, which may be termed, also, the supporting system* 
While the first is engaged in diminishing the volume, the other 
is not less active in renewing the blood. It is in these vessels 
that chyle is formed from our food, and that all the secretions of 
our body, all tumors, effused blood, matter, Sec. are returned to 
the blood. In this process, we find nature adhering to her beau- 
tiful simplicity. By a proper and uniform structure of these ves- 
sels, the various substances on entering them assume the same 
appearances, in consequence of their natural affinities in that 
state, just as they acquired other properties under different cir- 
cumstances in other parts. When these new properties are thus 
acquired, it is conveyed to the blood vessels, where it is changed 
from lymph to blood. It is in this manner, in continued fevers, 
where no nourishment is taken for weeks, that large quantities 
of blood are formed from the secretions, the absorption of which 
must be accelerated during the general increase of fibrous action. 
This is confirmed by the circumstance, that the animals in the 



104 

north, during the winter, are entirely supported by the absorption 
of fat — a secretion deposited in their cellular membrane. 

This statement of the principles on which the solids and fluids 
of our body are formed, will, I trust, .aid in removing the false, 
erroneous notions, that the fluids are the cause of our disorders. 
They have nothing to do with disease; — they are necessarily 
formed from the state of the solids, as ice becomes water below 
the freezing point. The correction of error is a step to the at- 
tainment of truth. Remember, then, that it is not the bile which 
causes bilious fever, but the state of the liver; that medicines are gi- 
ven to evacuate — to change the condition of the solids — the bile 
itself being a purgative. In like manner, in dropsy we pretend 
not to correct the water. We give medicine to revolutionize or 
change the solids, when the general system is disordered — not 
to thicken or thin the blood; and so on for every complaint. 

CIRCULATION OF THE BLOOD. 

The circulation of the blood is effected through the heart, ar- 
teries, and veins, of which the general account is this: The veins 
from every part of the body gradually collect, and by means of 
two large trunks, unite near the right side of the heart, and de- 
posite the dark-looking blood, called venous, into the heart on the 
same side: — this contracts and throws the blood, through four 
large arteries, into the lungs (or lights). Here it is spread over 
the inconceivably minute cells of the lungs, and is exposed to the 
action of the air we breathe. It receives some vital part from the 
air, and gives out some of its superfluous parts. This vital part 
of the air makes the blood of a very florid colour. It is then col- 
lected by the veins, and carried to the left side of the heart, which, 
by its powerful contraction, squirts or propels it all over the body 
for its various purposes. This produces a change again in its 
colour, from florid to dark, or from arterial to venous blood. It 
passes into the veins, and goes back to the right side of the heart, 
as at first stated, to be sent to the lungs; going through the same 
round as long as life lasts — perpetually renewing every part of the 
body, and supplying matter for all its secretions. It is this pow- 
erful action of the heart and arteries which causes our pulse, dif- 



105 

fering in frequency, depending upon our age and state of body.-— 
Its variations are well known to be very great; but in general it i$ 
about, in the minute, in an infant, one hundred and twenty; a 
child of five years, one hundred; a person of twenty years, eighty; 
of fifty years, sixty; of ninety years, about fifty. 

Besides the circulation of blood through the body for its vari- 
ous purposes, and through the lung's to receive the vital part of the 
air; there is a very different circulation through the liver, which 
secretes our bile — and it is of no less importance for our bodies. 
All other secretions are made by arteries, but in the liver it is 
effected by veins. The veins of the stomach, and all the parts 
connected with the digestion of our food, unite and go to the 
liver; there they divide into infinitely minute parts, and constitute 
the very substance of the liver. The veins are more feeble 
than the arteries, and the circulation of blood through them 
much slower: hence when the arterial action is excited, as by 
exercise or in fever, the veins act not so speedily, and of course 
the blood does not pass the liver as rapidly as it is sent to it from 
the large arteries of the bowels, spleen and pancreas, or sweet- 
bread. In consequence, it is thrown back on the parts behind: 
they become stuffed or gorged, and consequently produce not 
only great disease in the stomacjh and bowels, but it is extended by 
sympathy all over the system. The obstruction operates just as 
shutting the mill-gate of a race, which causes the water to fall back 
to stagnate in the dam. This at once shews you the vast import- 
ance of attending to the liver in all fevers; especially of relieving 
the bowels by free purging — emptying them not only of their 
contents, but of the blood with which their vessels are overload- 
ed, often the sole cause of the continuance of disease. 

RESPIRATION. 

Our power to inhale or take in air, arises from the action of the 
mid-riff, or diaphragm, aided by the motion of the ribs. The 
air penetrates all the cells of the lungs, on which the blood is 
spread by means of a cobweb kind of membrane. Here it im- 
parts to the blood a florid colour and new qualities, indispensably 
necessary for life; as without them life speedily ceases. The quan- 
tity of air consumed or destroyed, so that it is unfit for breath- 
N 



106 

ftig, is about five square feet in the hour. Hence the all-impor- 
tance of a constant supply of air in a pure state. 

The lungs at the same time give out something — a kind of mois- 
ture and fixed air; but what substance they receive from the air, 
is not known. Various theories have been advanced: but I believe 
the truth is, they receive nothing but the latent heat of the air, 
which, uniting to the blood, enables it afterwards, on change of 
state, to throw out sensible heat, or the warmth of our bodies.-— 
Hence nitric acid, and those things containing most latent heat, 
give generally to the blood its most florid colour. And it is a 
fact that the warmth of most animals is in proportion to the 
quantity of air they breathe. Those breathing most air, as birds, 
have a heat of about one hundred and six degrees; that of man's 
about ninety-six nearest the heart; that of fish is very inconsider- 
able. 

Sometimes the skin, in part, performs the functions of the 
lungs, as in suspended breathing; the body becoming cold, and 
absorbing from the air its sensible heat. Hence persons are much 
more easily recovered from drowning in warm weather than in 
cold, as the body then receives most heat from the water, or air. 
When parts become cold in warm weather, it arises from the 
state of the solids allowing the blood to become in a condition to 
attract more heat. The remedy is, to alter the state by rubbing, 
motion, and application of stimulants. 

PRINCIPLES OF DISEASE, AND ON WHICH CURES ARE 

EFFECTED. 

It has been stated that health consists in equal action or excite- 
ment, effected by the proper application of stimulants on the capa- 
city for life, or excitability. When these vary, disease exists: 
and it is in proportion to the variation. When stimulants ope- 
rate too powerfully, the excitement is high: and that constitutes 
the inflammatory state, which exists in all high fevers, marked by 
active, full or hard pulse, &x. The remedies, — rest, cold, bleed- 
ing, purging, and other evacuants, operate by reducing the excite- 
ment of the system. All which adds to the action, must in- 
crease the disease: And this holds good with local, as well as 
general affections. 



107 

But when the excitement is too low, marked by quick, feeble 
pulse, and great weakness, the disease is called low, nervous or 
typhus; and the remedies are those which increase action — as 
bark, wine, &c. All evacuations which weaken the system, must 
of course be injurious: And this holds good with local, as well 
as general affections. 

Now, as every disease may, at times, assume these two oppo- 
site states, it follows that what will cure in the one case, must in- 
jure in the other. Hence the absurdity of supposing there is any 
one cure for any one complaint. It is proper here to mention a 
law of the system respecting its excitability. When stimulants 
have been withdrawn, the excitability accumulates, and a little 
stimulus produces a great action. Thus a cold person, having 
his excitability accumulated from the abstraction of the stimulus 
of heat, on being carried to a warm place, is violently excited.— 
In like manner, the stimulus of spirit in the morning, when the 
excitability is accumulated at night, produces greater action than 
in the day; and so on of all stimulants. Now, when these stimu- 
lants operate violently, they produce indirect debility or weakness, 
as exemplified in intoxication, in eating too heartily after starva- 
tion, getting warm too quickly, &c. 

It would have been well for our art if such important princi- 
ples in medicine were always applicable; but a little experience 
will prove that a sick man requires something more than increas- 
ing or lessening the action or excitement of his body; though it 
be a most material object in the practice of physic. 

Doctor Rush, our illustrious countryman, maintained that there 
is but one disease, which is irregular morbid action in the ves- 
sels; and that the object of medicine is to subdue this and equal- 
ize the action. My idea is, that the actions of the vessels have 
not so much to do with disease as an alteration in their state, 
condition, or ramification, or construction; and that the object 
of medicine is to change this state, that they may return to their 
natural condition. For it is an important means of cure to sus- 
pend a diseased action in the vessels, or alter their unnatural state; 
because then, the natural tendency of the system being not to go 
back to disease, it will assume the healthy condition or state.-— 
It is with this view we revolutionize the system, by shocks of 



408 

cold, by violent vomiting, by great alarm, large doses of spirit, 
or opium, by bleeding to fainting, Sec. 

Again: another important principle on which cures are effected, 
is when disease exists in internal parts, to excite action on the 
surface. Thus, cupping, issues, blisters, Sec. on the skin, relieve 
affections of the lungs, bowels, brains, joints, Sec. 

In other cases, where a peculiar disease exists, we cure by keep- 
ing up a stronger actio i in the body, or creating another state of 
the solids. Thus mercury, and other highly stimulating articles, 
cure the venereal, and other diseases of a peculiar or specific 
nature. 

One of our most powerful means of curing diseases, is through 
the connection or sympathy of different parts of the body. A 
knowledge of these various sympathies is indispensably necessary 
for successful practice. In consequence of this sympathy, when 
one part is diseased, another part will take on diseased action. — 
Thus, when the womb is inflamed, there shall be great sickness 
at stomach in one person, in another affection of the breasts; the 
remedy of course to be directed to the part primarily affected. — 
Thus, when the stomach is disordered, there shall be excessive 
pain in the head. When the liver is affected any length of time, 
the skin, particularly of the face, takes on diseased action.-— 
When the stomach is filled with putrid meat, for example, the 
skin will sometimes become spotted. When a wound is made in 
one of the extremities, often the parts near the junction of the 
limb with the body will become affected. 

For example, in curing by means of this sympathy, we excite 
the kidneys to an increased secretion of urine, by water and salts 
in the stomach. We cause the dispersion of large collections of 
matter, by the administration of an emetic, by cold, and so on. 

This short view I have given of a few general principles, I hope 
will at least be sufficient to make such a forcible impression on 
your minds, as will for ever root out all belief in great cures by 
quackish or particular prescriptions. Nothing can be more cer- 
tain than that each case of disease requires the exercise of sound 
sense for its treatment. The administration of an article to one 
patient, because it cured some others, must of course be improper, 
unless there be reason for believing that the state of the different 



469 

persons is alike. Admitting what I have advanced to be true, 
can you put further faith in stories of great cures by treatment 
contrary to principles — to common sense; although many should 
tell you — although you might fancy you saw the effect yourself? 
Such instances of recovery only show the power of nature in 
restoration: the supposed remedy was not the instrument. Could 
you believe that any stimulating article, as brandy or opium, or 
the like, could cure an inflammatory fever? or that heat, restless- 
ness, food, or stimulating drinks, could fail making it worse?— 
Could you believe that in diseases of low action, called nervous 
or typhus, that great evacuations would fail to make it worse, 
although an hundred told you to the contrary? Indeed, you may 
rely on it, although sometimes it may appear very difficult to 
dose a person to death, there is not one disease which ought not 
to be treated according to principles, and not one to be treated 
according to " guessing/' 



MATERIA MEDICA, 



OR 



MEANS OF CURING DISEASES. 

I have to remark, that in no one of the departments of medi- 
cine, has there been more absurdities and falsehoods published, 
than in this called " materia medica," or means of curing diseas- 
es. Not an age has elapsed, without the substitution of new and 
abandonment of old articles. Instead of studying the most judi- 
cious use of the most simple and common means of relief, there 
has been a general search after some rare and wonderful remedy 
for disorders. Professor Chapman, of Philadelphia, in his work 
on this subject, says, " There never was a science so overcharged 
with superfluous lumber, as the materia medica in its present 
sta* ^. I have with intrepid decision endeavoured to cleanse this 
accumulation, by expunging whatever substances are known to be 
inert or redundant. " It is my intention to follow the example of 



no 

the Doctor; confining myself to articles which may be safely 
trusted in the hands of all, with proper directions: and these, too, 
are chiefly those of intrinsic worth, in the treatment of nine 
hundred and ninety-nine diseases in the thousand. I have no he- 
sitation in declaring- it — and I am sure no good physician will 
deny its truth, — that, by seasonable exercise and rest; by diet and 
family drinks; by variations in air and water, from cold to hot; by 
irritations of the skin by hard rubbing, scarifications, cupping, 
blisters, whipping, and burning; by purging, glistering, and puk- 
ing with the most common articles; by fomentations, poultices, 
and simple ointments; by occasional compression; and, lastly, by 
bleeding, which ought to be universally understood; — ten thou- 
sand times more good can be done, than by every article in the 
apothecary shop. 

QUALIFICATIONS OF ATTENDANTS ON THE SICK. 

There is very little doubt but that recovery from sickness de- 
pends materially on the nurse, or attendants upon patients; as 
Well upon refraining from officious interference, as giving timely 
attention. All the necessary qualifications can seldom be found 
in any one; but the nearer they can be got to follow the following 
directions, the better: 

Great attention to cleanliness of the mouth, the body, the bed, 
and the room; often washing the mouth, and speedily removing 
all filth; changing the clothes with as little labour to the sick as 
possible — the greater the perspiration, the more frequently. 

Keep the room always of a moderate, temperate degree of 
warmth, regulated by the season, with that all-important article, 
more wanted in sickness than in health, fresh air, to be gently ad- 
mitted without a current, and therefore requiring no bed-cur- 
tains. 

Keep quiet; disturbing the sick as little as possible, by talking 
or making any kind of^oise; never communicating any bad 
news, — remembering that> perfect rest to the patient is of great, 
importance. 



Ill 

To administer with faithfulness, and in the most palatable 
state, the medicines prescribed, and observe their effects: which 
report to the prescribes Unpalatable pills may safely be surround- 
ed by a thin piece of paper, or gold leaf; the great disgust to me- 
dicine being frequently caused by the nauseating manner in which 
it is given. 

Have in readiness a bed-pan; and never suffer the patient, 
when very weak, to set up on it long, as in that state they 
often expire from exhaustion. A cheap and ready mode, at 
all times, of making a proper pan, would be to saw down a pig- 
gin to a depth of three inches, on which a top can be placed, 
with a hole in it like that of a necessary. 

To keep constantly a supply of various articles for drink, in a 
proper state, of the weak kind of teas, in addition to such medici- 
nal drinks as are prescribed, which, when solely enforced, prove 
disgusting: remembering to give but small quantities at a time; 
not very cold, as they increase thirst. Drinks can be made of 
any of the garden herbs generally used for teas; of toasted bread, 
barley; of apples, cut up in water; of gruel, elm-bark, flax-seed; 
of lemonade; of chicken, or lean fresh meats; of tamarinds, vine- 
gar, or cream of tartar; of currant jelly: in short, of any thing 
ever used in families, possessing no stimulating powers. Spirit, 
in any state of combination, wine, porter, cider, and the like 
stimulating drinks, unless particularly directed, or called for 
from fainting or the disease of the patient, must be carefully 
avoided. 

Diet is a subject, too, to which the nurse should pay the great- 
est attention. As this must vary with each varying state of the 
system, it is impossible to give any further directions in this 
place, than to state, that in high fevers, it should be very mode- 
rate, entirely of small quantities of vegetables; and that in low 
fevers, it should be of well-seasoned, palatable food; the more 
like that the sick person had been accustomed to, the better: but 
taking care to give it often, and little at a time, as a full meal, in 
such states of system, often produces death. 



lid 



GLYSTERS. 



Administer a glyster when required, of whatever article direct- 
ed. These often operate only by their bulk; and, unless given as 
medicine, their component parts are not material: they are general- 
ly made of warm water, with salt, or soap, or sugar, or oil; and the 
common glyster-syringe is the instrument used. In order to give 
it, the patient should be laid on the side at the edge of the bed; the 
bottom a little over the edge; the knees drawn up near the belly; 
and then the pipe, with the finger before it, is to be applied to the 
fundament; and on pushing it in, the finger is to be taken away. 
It is gently to be pushed (the operator's hand is to be near the 
thighs,) a little backwards, or towards the back bone, and then the 
contents is to be forced out by pushing gently the handle of the 
syringe with one hand while with the other the syringe is firmly 
held, or by squeezing the bladder when it is used. On intro- 
ducing the pipe, it is best for an assistant to hold open the cheeks 
of the patient's bottom. A small pewter squirt will sometimes 
answer in giving injections, as well as the largest. It only 
requires that the injection should be made stronger, to irritate 
and excite the lower part of the gut, which brings on the action 
of the rest of the bowels by sympathy. 

CUPPING. 

An ability to cup is a very necessary qualification for attendants 
on the sick. It is an operation, so easily performed, and often so 
important, that all ought to learn how to do it. If blood is to be 
drawn, the part ought to be cut in many places, each cut about 
the length and distance of a finger-nail apart; the cut only deep 
enough for a little blood to flow; then a glass, or a mug, or a 
gourd, of suitable mouth, is to be taken from a basin of hot water, 
and fitted to the part; then a bit of paper, about as large as a 
dollar, dipt in spirit, is to be held near the cupping-glass, and set 
on fire by a candle, when, as soon as it blazes, the cupping-glass 
being leant on one side, the burning paper to be quickly thrown 
into it, and then the glass applied close to the skin, as when 
first fitted. As the paper burns, the air will consume, and there^ 



113 

by cause the extraction of the blood. Paper burnt brown, or 
any very inflammable article, is often made to answer; but the 
use of spirit is to be preferred. This is an operation which 
any one can perform; it being very frequently done by the old 
negroes. A small quantity of spirit put in the cupping glass and 
set on fire will answer without paper: and its blaze is less apt to 
burn. 

DRESSING BLISTERS. 

An ability to dress blisters is very requisite, and easily acquis 
ed. If it be desirable not to keep the blister running, then make 
a very small opening with a needle or scissors, and let out the 
water very slowly, holding cloths to absorb it; and apply to the 
part collard leaves, freed of their stem, warmed and rubbed 
before the fire. Plasters of tallow, or suet, or of hog's lard, 
will answer. When the Mister is to be kept running, the skin 
should be cut off with scissors, and such stimulating ointment 
applied, as shall be directed. Basilicum ointment is often used, 
as also a very weak blistering plaster* 

BANDAGES. 

The proper application of a bandage, ought to be well under- 
stood. That most commonly used is a long piece of cotton, lin- 
en, or flannel, about three inches wide, rolled up smoothly; — its 
application is to be equal, compressing no one part more than 
another: and to insure this, you begin at the extremity of the 
toes or fingers, and wind it around, making each edge lap an inch 
over the other; and when the part over which it goes is irregu- 
lar, the bandage is to be so turned, edge for edge, that it shall 
become suited to the bulging or irregular parts it has to pass 
over. This, properly applied, is a powerful remedy in sores; but 
does great harm when put on so as to produce unequal pressure, 
interrupting the circulation, and thereby increasing the disease. 

There is another kind of bandage called the eighteen tailed ban- 
dage — because generally made of that number of slips of cotton 
or linen, of length sufficient to go once and a half around the part 
to be bound up. This is used when it is improper to move the 
O 



114 

limb. These detached pieces, in number sufficient to bandage 
the part needing it, are put under the limb at its first dressing- 
one to overlap the other about an inch ; then the ends are to be 
wound smoothly around the limb, the one end over the other; and 
they of course will lap half around the part and each end will 
bind the other. When they are to be removed for dressing, and 
are found filthy — each can separately be pulled out with a clean 
one attached to its end, and in that manner carried to replace that 
removed, without moving the limb. 

BLEEDING. 

The next qualification which I shall mention, and believe ought 
to be nearly universally understood, is bleeding. Were the abili- 
ty to do it general, many lives would be saved, which otherwise 
might sink from the want of its timely relief. When it is desi- 
rable to bleed at the bend of the arm, the first object is to tell the 
situation of the artery; it will be found beating, a little below the 
middle towards the lower part: This is to be noticed; and the com- 
mon bleeder should never bleed near it, but as far from it as he 
can. About two or three inches above the elbow, a bandage should 
be applied, and drawn so tight as to prevent the blood from pas- 
sing up in the veins, but not so as to prevent the feeling of the 
pulse at the wrist; — then the operator is to feel for a vein not 
over the artery, and with his left thumb press on it, as his fingers 
grasp the arm; he is then to hold firmly the lancet between the 
right thumb and finger; to let the three other fingers rest on the 
patient's arm, and gently in an oblique or sloping direction push 
the lancet into the vein, and carry it forwards, (not downwards,) 
until the blood oozes out below, when he is to take it out. It is 
wrong to push the lancet in suddenly, as some do. The ope- 
rator should understand what he is about, and be cool and collect- 
ed. It would be well for the patient to clench his fist, and for 
the operator to push up the blood towards the bandage, before 
operating. If the blood do not flow freely, the pulse should be 
examined, and if not perceived, the bandage is to be loosened. — 
The arm ought not to be moved while the blood flows, as the 
skin may get over the opening in the vein, and the blood collect- 
ing under it will form a dark tumour* called Ecchymosis. For 



415 

the cure of this, perfect rest, cold washes of vinegar or brandy 
and water, or a solution of sugar of lead, are generally sufficient. 

When a sufficient quantity of blood is taken, the bandage is to 
be removed; the arm elevated perpendicularly; then wiped; the 
orifice in the vein is to be closed with the thumb and finger; 
when some folds of a rag are to be applied to it, and kept in place 
by a bandage drawn above and below the elbow, not so as to im- 
pede the circulation. 

Sometimes there is a difficulty in stopping the blood; and also 
the arm bleeds a second time: — you should then keep the arm 
for some time elevated, hold the lips of the opening together for 
several minutes, apply cold water to the arm, and then renew the 
bandage as before. The longer the arm is kept elevated and 
quiet, the better. A large covering of sticking plaster will often 
stop the bleeding. 

When a bleeder has been so fool-hardy as to cut over and into 
the artery, it is known by the very florid colour of the blood, and 
its coming out by jets. This requires more of the above efforts 
in stopping the bleeding, and an instantaneous resort to surgical 
skill for taking up the artery. 

In order to bleed in the foot, a bandage should be tied around 
and above the ankle, and the most elevated vein carefully opened. 
The point of the lancet should not be pushed far downwards, as 
the tendons underneath might be Avounded. By putting the foot 
in warm water, the flow of blood is expedited. 

Bleeding at the temporal artery is a very simple operation; and 
when blood cannot be taken safely from the veins, it may and 
should be got from the temples. By feeling a little above the 
ear the artery may be felt beating: and any one may safely cut 
down to it with a common lancet. The best place is about two 
inches above the ear. The operator, feeling the artery, is slowly 
to cut the skin, in the direction of the course of the artery, near 
half an inch. Then with the thumb and finger of the left hand 
he is to open the cut, and wipe the blood off: when, on seeing the 
motions of the artery underneath, he is to make a small puncture 
across it, or in the direction opposite to the first cut in the skin. 
If the blood do not flow freely, warm water should be used to 
wash off the clots of blood, or the opening may be enlarged. Io 
some cases, it may be requisite to cut the artery nearer the ear. 



116 

When sufficient blood is taken, a piece of adhesive plaster may 
be applied to the wound — the edges of which should be brought 
close together; a moderate compress dipped in cold water and 
kept on the opening by a bandage around the head, may stop 
the bleeding: — Sometimes, however, to do this, it is necessary to 
divide the artery entirely. 

TO APPLY THE WARM BATH. 

The next qualification I shall state for the attendants of the 
sick, is an ability to apply judiciously the warm bath. This 
powerful remedy is often rendered useless by the injudicious 
manner of using it, and the unnecessary labour taken to prepare 
it. Bathing the feet may be done underneath the bed clothes — 
the patient drawing the feet up near his bottom, where the tub 
is to be placed. When general bathing is required, the best 
mode is to heat stones, or irons, and put them in the water as is 
done for scalding hogs. A common barrel, or half pipe, leaned 
on one side, with a large opening in the upper part of the staves 
and half the head taken out, makes an excellent as well as conve- 
nient bathing machine. 

But the chief advantages of a bath may be obtained by steam, 
and with little trouble. If the patient be weak, he should be rolled 
on a fresh blanket at the side of his bed, and half of the blanket 
thrown over him. Underneath this, a piggin of water should be 
placed and hot stones or irons put in it as long as necessary. — 
When discontinued, the patient should be wiped underneath the 
blanket; and dry and warm clothing being prepared, he can be 
rolled over on it without the least exposure to cold air. His 
head should never be underneath the blanket while he is steamed, 
unless 4 be desirable to produce profuse sweating. And when 
the steam is only required for his lungs, it is only necessary to 
cover his head: and with a small vessel of water and hot stones, 
all the advantage can be derived that ever was had from the fam- 
ous inhalers, and their substitutes coffee and tea pots, which have 
often ended in scalding the patient. In consequence of the great 
saving of trouble from these contrivances, as well as the expense 
of bathing machines, the use of the bath should be more general 
when circumstances call for it. Indeed, the great neglect of this 



117 

important remedy can only be attributed to the heretofore diffi- 
cult task, or preparation of the necessary means; which will cer- 
tainly be obviated by an observance of the mode suggested. 

PRECAUTION IN FEVER. 

v 

Remember never to let a patient confined with a long continued 
fever, remain more than half a day laying on one part; as the 
compression, if too long continued, will produce mortification on 
the part, and the most dreadful sores: often more annoying, more 
painful and fatal, than the original disease. From neglect of this 
precaution, I have seen almost half the back destroyed — particu- 
larly about the buttox, the shoulders, and the hips. 

When patients have got over their fevers, great weakness re- 
mains: and slight efforts, unless very judiciously made, are apt 
to prove fatal. In taking exercise, in evacuating the bowels, the 
utmost circumspection becomes necessary. A person much re- 
duced may as readily die of weakness as of disease: and should, 
in this exhausted state, be watched with that kind of care and 
attention one bestows in raising the flame of a sinking lamp. 

POULTICES. 

Lastly, to make poultices properly, is no unimportant qualifica- 
tion. The chief object of them, is to relax the skin over which 
they are placed and allay irritation. When made of Indian corn 
meal or bread and milk, they should be soft, and the part going 
in contact greased. The best is made from the powder of flax- 
seed, made by pounding it or grinding in a toffee-mill.— -The 
powder is gradually to be added to hot water and stirred until it 
is of proper consistence. A poultice made of slippery elm bark 
cut small and boiled with a little meal, is very soothing: as also, 
one of a thick jelly of water-mellon seed, obtained by well boiling 
the seed in a little water. In most cases the chief good is deriv- 
ed from the moisture or warm water, which can be fully had by 
simply dipping cloths in hot water and applying them, to be re- 
moved on becoming cold. 



118 



CLASSIFICATION OF MEDICINES. 

Before detailing this, I will observe that the mode by which 
medicines operate on the body, has long been a subject of inves- 
tigation. They were supposed to affect the fluids of the system, 
and hence were given to lessen their acrimony or sweeten them, as 
many have termed their effect; to thicken or thin or in some way 
to purify the blood. But it is now admitted by all the intelligent 
of the faculty, that medicines operate on the solids, and affect 
them through the nervous system, which gives the solids the ca- 
pacity or susceptibility of being acted upon: and, moreover, that 
it is through the connection or association of one part with ano- 
ther, called sympathy, arising from the nervous system, that me- 
dicines affect various parts of the body when applied to some 
other and often most distant part. The effect of some medicines 
is so quick that it is not possible it can be by any other mode; 
for when a person takes a large dose of laudanum, or strong spi- 
rit, or tobacco, or fox-glove, or any other poison, he instantly falls 
down, deprived of strength and sensation. Surely this can only 
be through the nervous system, in these cases; and it is the case 
in the operation of all medicines. 

I repeat the remark, that the medicines wanted for common 
practice are very few: although such an immense variety is to be 
found in apothecary shops. They are all arranged under differ- 
ent heads, according to their most conspicuous effects upon the 
system: a very defective mode, but the best which has been adopt- 
ed. Under each head I shall mention those deemed of most im- 
portance in common practice: But I shall state the remainder, 
as some of them may be- preferred by others. 

It is to be remembered that in taking physic of any particular 
kind, the system becomes habituated to it and requires an in- 
crease of dose, just as persons require an increase of spirit, tobac- 
co, Sec. Therefore that medicine of a similar nature ought often, 
when practicable, to be substituted for the one previously taken. 

The doses stated are for adults: and are of course to be varied 
to suit the state of the patient; as what would be very proper in 
a strong, vigorous state of the body would produce death in a de- 
licate or reduced person. The doses for children are not men-* 



119 

tioned: because as they want but few, it is -more proper to state 
them when treating of their complaints. As a general rule, — but 
it must be considered as exceedingly exceptionable, and requiring 
always the exercise of a sound discretion, — the dose for an infant 
under one year old, is one-twelfth part of that for a man: a child 
of five years old, one fourth; of ten years, near one-half — and so on. 

1. STIMULANTS. 

These are medicines which excite a general action over the 
whole system: but of short duration; exemplified in the effects of 
a drink of grog. A rule respecting them, when they are requir- 
ed, is that they are to be frequently renewed: the quantity gradu- 
ally increased: and the kind changed. The most common and 
the best, are our much-abused intoxicating liquors in the various 
shapes of spirituous liquors, wines, porter, ale, cider, &c. Those 
which are considered of the strictly medicinal kind, are — 

Spirit or Oil of Turpentine, The dose is from three to four tea 
spoons full. 

Sulphuric Ether. Dose from one to three tea spoons full, mixed 
in half a tea cup of water. 

Spirit of Lavender. Dose about a desert spoon full. 

Volatile Alkali, called Volatile Salts. Dose from ten to fifteen 
grains, made into a pill with syrup. Of the same nature is 
Spirits of Hartshorn. Dose from one to two tea spoons full. 

Tobacco, particularly on those accustomed to its use, operates as 
a powerful stimulus. 

Teas of Hops and our garden herbs, as well as of those imported, 
are also of this class. 

Garlic and Onions are stimulants as commonly used; and also all 
the pungent articles of gardens. 






120 

Ofiiunt and its jirejiarations of Laudanum and Paregoric, in small 
doses, are equal in stimulating power to spirituous liquors. 

Blisters are often used to stimulate the whole system, and 

Mercury stands first on the list of permanent stimulants, and is of 
an all-pervading character when taken in small doses of Ca- 
lomel and long continued. 

Articles to irritate the nose, as Volatile Alkali, Snuff, Assafsetida, 
burnt Feathers, and any thing very offensive, are sometimes 
properly used to rouse to momentary action. Sudden burn- j 
ing and irritating the skin by whipping, have often done good 
in rousing the system. 

All the Sto?nachics and Cordials in common use, particularly the 
various essential oils of Peppermint, Cinnamon, &c; all our 
Spices, as Pepper, Ginger, 8cc; are often used to rouse the 
whole system to action, and with very good effects. While 
referring to stomachics, it may be as well to mention those 
producing discharges of wind from the stomach, called 

CARMINATIVES, as 



Caraway, ~*1 

Dill, and /- 
Fennel J 



Seeds. Taken in the form of strong teas. 



Calamus Root, procured from our marshes, when chewed and swal-* 
lowed, proves a valuable article in expelling wind: and so are 
Spirits of Hartshorn, and of Turpentine, and of Peppermint, 
and most of the pungent articles of our gardens, as Horse-ra- 
dish and Turnip, Sec. 

Peruvian Bark Bitters, and in short it is difficult to say what is 
not a stimulus when properly managed: from every medicine 
ever used, to bleeding and cold water suddenly thrown on 
the body. In over doses, they all suddenly prostrate the 
powers of life, as do Spirit and Laudanum. 



131 



2. ANTISPASMODICS 

Are those stimulants which are supposed to remove spasm, or 
a kind of cramp in parts of the body. Of these the most remark- 
able are— • 

Opium and its preparations in large doses, depending on the ur- 
gency of the case. 

A draught of hot Toddy. 

Sulfihuric Ether. Dose a small table spoon full. 

Asaf&tida. Dose in substance, eight or ten grains: in Tincture, 
three or four tea spoons full. 

Musk. From ten to twenty grains. 

Oil of Amber. From ten to twenty drops. 

Essence of Peppermint. In very large doses. 

But among the means of removing spasm, the best I ever ap- 
plied, are free use of the Warm Bath, bleeding, fomenting, and 
hot applications to the skin, over the parts most affected. 

3. ANODYNES. 

4 

These allay pain and produce sleep, as exemplified in the effects 
of Laudanum on most people. The chief on this list are— 

Opium, in doses of from two to five grains. 

Laudanum, made by dissolving an ounce of Opium in a pint of 
spirit, of which fifty drops are equal to two grains of Opium. 

.Paregoric, made by adding half a drachm of Opium, or its equal, 
one ounce of Laudanum, to a pint of spirit, and mixing with 
P 



them half a drachm of Flowers of Benzoin, the same quantity 
of Oil of Aniseed, and one scruple of Camphor. The dose 
three or four tea spoons full. 

Spiders Web, formed by the black spider, taken from dark cellars 
and barns, has lately been highly extolled for its anodyne 
eifect. It is taken in doses of five grains. 

Hops. Of which a strong tea may be taken. 

The Warm Bath and Bleeding very, frequently relieve pain and 
produce sleep, especially in high fever. 

There are some other medicines besides the above, sometimes 
used to relieve pain. I never used them for the purpose, or saw 
them used. — They are the Fox-glove, Nuxvomica, Tobacco, the 
Woody, the black and the deadly Night Shade, black Henbane,. 
Jamestown Weed, &c. 



4. TONICS. 

These are medicines which are supposed to act particularly on 
the fibres of the body, by giving them tone or strength, exempli- 
fied in the effects of the famous 

Peruvian Bark. Of this there are three kinds — the red, the yel- 
low, and the pale. It is difficult to say which of these is the 
best; but I would recommend to procure that which is fresh 
and least in demand at the time, as the temptation to adulte- 
rate is least. The dose is from two to four tea spoons full in 
a wine glass of water, taken every three or four hours when 
there is no fever. When it does not agree with the stomach, 
it is given in decoction or infusion, made by adding an ounce 
to a quart of hot or cold water: to which, as to the bark in 
substance, is often judiciously added a little Virginia Snake- 
root, or Ginger, or Lemon-peel, or any of the cordials — par- 
ticularly wine, spirit, &c. 



123 



i 



Dogwood Bark, 

Red Oak Bark, and J*- Reduced to fine powder, and ta- 

Bark of the Wild Cherry Tree, 

ken in doses of thirty or forty grains, or drunk in strong de- 
coction, will be found nearly as good as the Peruvian Bark. 



Angustura Bark, in doses from five to twenty grains, is by some 
esteemed equal to the Peruvian. 

Columbo Root, in doses from twenty to thirty grains, or taken in- 
fused in water or wine, — an ounce to the quart — is a power- 
ful tonic. 

Gentian Root and Quassia are among the strongest bitters. A ve- 
ry common bitter tincture is made of two ounces of Gentian, 
one ounce of Orange-peel, and half an ounce of Canella Alba* 
in a quart of spirit or wine; and it is a tonic, 

Bitters, in general, give tone to the system; and among those most 
used are— 

Chamomile Flowers, Hops, Virginia Snake Root, wild Horehound, 
wild Centaury, and Wormwood, all separately or in combina- 
tion, made in strong decoction, or added to wine or spirit, 
make agreeable and mild bitters. 

Charcoal in powder, in doses of a tea spoon full once in two hours, 
has been found a valuable tonic. 

Vitriolic Acid, diluted as in the Elixir Vitriol as it is called, in do- 
ses of thirty or forty drops, with so much water as to render 
it palatable, is considered a tonic, and is often given with, 
Bark and Bitters. 

Nitric Acid. This is a most powerful tonic; especially in chronic 
affections of the liver and patients exhausted with Mercury^ 
or the venereal disease. It is generally given a drachm in 
the course of a day, diluted in a quart or more of water, and 
sweetened to render it palatable. To be drank through at 
quill, to save the teeth. 



124 

Arsenic in substance, made into pills, each containing one-eighth 
of a grain, is one of the most powerful tonics ever used. To 
make the pills, take four grains of Arsenic and a tea spoon 
full of flour: mix them well, then with water make a paste, 
and divide it into thirty-two pills: of which, one is a dose, 
taken two or three times a day. But it is better to take it in 
the form of the solution called Fowler's and sold as Ague and 
Fever Drofis, of which the dose is from four to six drops, 
two or three times a day: and like the medicine in substance, 
is to be gradually increased. 

Iron has long been considered as a tonic — not only when in sub- 
stance, but when in solution, as in the state of chalybeate wa- 
ters. The filings of Iron were once much used; but a better 
form is the Rust of Iron, in doses from five to ten grains, 
thrice a day. 

Green Vitriol. Dose from two to four grains, twice a day. 

Tincture of Steel. Dose from fifteen to thirty drops, thrice a day, 

Chalybeate Waters owe their strengthening qualities to Iron, 
which is dissolved by the agency of fixed air. By putting a few 
grains of the rust of Iron in a bottle, and having it filled with 
the common Soda Water as it is called, as valuable a chaly- 
beate drink may be had as from any of our spings, to which 
so many resort. 

White Vitriol, in doses of two or three grains, has occasionally 
been given for its strengthening effects; and so have prepara* 
tions of Copper, Silver, Bismuth, Sec. — articles seldom used. 

Tonics are not to be given in high fevers. Doctor Chapman, 
in his work on this subject, judiciously lays down the following 
outlines for the administration of tonics to overcome debility: 

1. Let the diet of the patient be accommodated to the state of 
the system. After recovering from violent disease — it should at 
first consist of the lightest vegetable matter, as Rice, Tapioca, 
Arrow-root, and Sago, also Irish potatoes: Then Eggs, Oysters, 



425 

Wild-fowl, Poultry, and finally Beef and Mutton: generally select- 
ing that article most agreeable. 

2. Let the patient always eat much more frequently than at 
other times; as the stomach, like a school boy, is always doing 
mischief unless well employed. 

3. Solid food is to be preferred: and, also, the more simple the 
article the better. 

Next, he says, in point of strengthening power, is the Hot and 
Cold Bath. The Hot Bath acts directly as a stimulus; the C Id 
acts differently, at first producing languor and depression, after 
which the system re-acts and is invigorated. It is not to be used 
when the system is debilitated by fatigue or in a state of perspi- 
ration: It is best used in the morning or mid-day. In the warm 
Bath the patient may continue longer. On coming out, the pa- 
tient should be wiped dry. The cold bath should not be con- 
tinued when followed by great depression for a length of time. 
Frictions on the skin may then be applied freely: and stimulating 
articles, as Salt, Red Pepper, Acids, Sec. 

5. ASTRINGENTS. 
| 

Medicines which act so as to stop the discharges from the bo- 
dy, whether of blood or any of its secretions, are called astrin- 
gents, and they are generally allied to tonics in their effects. 

Sugar of Lead, in doses of from two to five grains in urgent cases, 
I believe to be the most certainly to be relied on. But in 
mild cases, it ought not to be used until others shall have 
been tried. 

Nut Galls in powder. The dose from ten to twenty grains. 

Black-Bery Root. That of the running brier, called Due Berry f 
is the best. An ounce of it bruised and put in a pint of wa- 
ter. The dose about half a cup full, repeated often. 

Alum. The dose five to ten grains: also small doses of Rhubarb. 



186 

White Oak and-Chesnut Bark, in substance or strong decoction, are 
powerful astringents. 

Gum Kino and Catechu come under this head. The dose of either 
is from ten to twenty grains. 

Sulfihuric Acid, diluted with water to be palatable and freely 
drank, was formerly highly esteemed. 

Lime Water, particularly when acid exists in the stomach, has a 
similar effect. The dose is a tea cup full, with equal quan- 
tity of milk. 

Ojiium in substance and Laudanum are sometimes used with great 
success in restraining profuse discharges. 

Common Salt, A table spoon full Dr. Rush recommends, to stop 
bleeding of the lungs. The dose may be repeated. 

Charcoal in powder, in small doses, has an astringent effect upon 
the bowels: also when applied to bleeding parts — as the nose,, 
gums, &c. j 

Cold Water is ranked amongst the most useful of astringents.— 
It is the best application for local bleedings. 

6. EMETICS. 

Medicines to excite vomiting, are commonly called Emetics; 
Their operation is to be kept up by drinking warm water. 

Ifiecacuanhde is the mildest of these. The dose is from fifteen to 
twenty grains. 

Tartar Emetic is the medicine most generally used for exciting 
vomiting. The dose is six grains, in as many spoons full of 
warm water; one of which is to be taken every ten minutes 
until it freely operates. It is often preferred in the state of 



127 

jbitimonial Wine, which is made by adding two scruples of Tar- 
tar to two ounces of hot water, and when it is dissolved add- 
ing half a pint of White Wine. The dose is about two tea 
spoons full every ten minutes, until it operates. 

White Vitriol is the most expeditious of the emetics. The dose 
about twenty grains in a cup of warm water. 

Blue Vitriol is sometimes given for vomiting. The dose from 
three to five grains dissolved in a wine glass of warm water. 

Tobacco in snuff, or a little in tea, has been- occasionally used 
when other emetics were not at hand. 

Squills, in doses of ten or fifteen grains. 

7. PURGATIVES. 

Medicines which increase the discharges from the bowels are 
called purges. These, when used to produce but slight effect, are 
termed laxatives. Their operation is to be promoted by mild 
drinks. The most commonly used are— 

f 
Calomel. The dose fifteen or twenty grains in form of a pill. 

May Afifile, "J 

Jalap, and > the roots. Dose from forty to fifty grains, mix- 

Rhubarby J 

ed in syrup or warm water. 



) 0iL 



Olive 
and }. Oil. A common wine glass full, with a little spirit. 

Castor 



Gum Gamboge. From four to eight grains, powdered and made 
into a pill with syrup. 

Aloes. From four to eight grains, powdered and made into a pill 
"vyith syrup. 



128 

Glauber'] 
and I Salts. One to two table spoons full. Only half the 

JEjisom J 

quantity when they have dried into a white powder. The 
dose is made less unpleasant, if Lemon juice or a little Vine- 
gar be added to the solution. 

Magnesia calcined. Two tea spoons full, to be taken in milk or 
water. The uncalcined dose to be a table spoon full. 

Cream of Tartar. A table spoon full in a tumbler of water. 

Manna. One or two ounces dissolved in hot water. 

Flower of Sulphur. From five to ten r tea spoons full. 

Ox Gall. Two small table spoons full purge freely. 

Charcoal in powder. One table spoon full in thin syrup. 

These medicines should in general be taken on an empty sto- 
mach, and in a state of combination with each other. The fol- 
lowing are common and valuable combinations: — Fifteen grains 
of Calomel with one of Tartar Emetic. Ten of Calomel and 
twenty of Jalap. Three of Gamboge with ten of Calomel. Twen- 
ty of Rhubarb and thirty of Magnesia. Salts, Sennae, and Man- 
nae, of each half an ounce in a pint of hot water, to be taken one- 
fourth every hour. Cream of Tartar and Sulphur, equal quanti- 
ties about a table spoon full. To a dose of Salts add a grain of 
tartar. A very good compound, ridiculously called Anti-Bilious 
Pills, is made of five grains of Calomel, ten of Jalap, two of Gam- 
boge, and half a grain of Tartar Emetic. 

In order to arrest the too violent operation of purges, give a 
dose of Laudanum of twenty or thirty drops, or an injection of 
twice the quantity, applying hot cloths to the stomach. 

Sometimes the bowels are in a torpid state and purgatives will 
not operate, although a variety be given and in large quanti- 
ties. In these cases, instead of continuing to administer so much 
medicine, which may kill, as I have known it do when the sensi- 



129 

bility of the bowels became restored, — no matter what season- 
pour over the patient's belly a pitcher of the coldest or ice water.— 
The success attending this extraordinary practice— -which I early 
learnt, but do not recollect where, — once gave me an extensive 
practice in a neighbourhood near the place I then lived. 

8. DIURETICS. 

Medicines which increase the secretion and discharge of urine, 
are called Diuretics. These are principally, 

The mild -vegetable Alkali, called Carbonate of Potash. Dissolve 
half a drachm in a pint of water; to be taken in a day, in 
five or six equal parts. 

An ounce of Cream of Tartar in half a gallon of cold water, drunk 
in the course of the day. 

Nitre, called Salt Petre, one drachm dissolved in a quart of wa- 
ter or any tea, to be taken through the day. 

Spirit of Nitre, in doses of a table spoon full, mixed with a glass 
of water. Dose to be repeated twice a day. * 

Root of the common garden Parsley, taken in strong decoction in 
the course of the day. 

Doctor Chapman calls these the mild Diuretics; to which I 
would add — drinking large quantities of cold water, of Soda Wa- 
ter: of Cider and water: of weak Lemonade; the operation of 
which will be expedited by exposing the surface of the body for 
a little time to cold air, or water in the shower bath. 

\ 

The more powerful Diuretics are— 

Fox-glove, called Digitalis. The dose in substance, is one grain 
of the powder of the leaves in a pill, morning and night. Of 
the Tincture, the dose is from fifteen to fifty drops: the quan- 
tity to be gradually increased. 

Q 



130 

Tobacco — one ounce infused in a pint of water, of which fifteen or 
twenty drops make a dose, — has been used sometimes with. 
advantage. 

The stimulating Diuretics are— 

Sjianish Flies, The dose in substance, is one grain: of the Tinc- 
ture, from fifteen to forty drops. 

Venice Turpentine. Dose five or six grains. 

Oil of Turpentine. Dose from one to two tea spoons full. 

Balsam of Copaiva. Dose thirty or forty drops. 

Squills, or Sea Onion. When dried, the dose is from three to five 
grains: of the syrup, a desert spoon full. 

Vinegar of Meadow Saffron^ or Colchicum. Dose a tea spoon full. 

Seneca Snake Root, reduced to powder. Dose twenty grains.— 
Also taken in decoction, an ounce to a quart of water. 

9. SUDORIFICS. 

Medicines which excite perspiration are called diaphoretics 
or sudorifics. As this may be excited by such a variety of means, 
it is impossible to be precise on the subject. The state of the 
skin depends very much on the state of other parts, particularly 
the stomach, lungs and brain. Any thing which affects the one, 
affects the other. 

Antimony, in its various preparations, affects the stomach, and 
through it, the perspiratory parts. At one time, the golden 
Sulphur of Antimony was much used in broken doses three 
or four grains. The Antimonial Powder, analogous to the 
. once celebrated James' Powder, in doses of six or eight grains, 
is now much used. But by far the most frequent and the 
best mode of giving Antimony, is in the form of a weak so- 



131 

lution of Tartar Emetic, in small and repeated doses, to keep 
up a slight sickness at stomach, which is almost univer- 
sally attended with perspiration. This is often given in 
combination with Nitre and Calomel, forming a favourite 
medicine of Doctor Rush and his pupils, called the Nitrous 
Powders. The directions for making them are — to sixty 
grains of Nitre add sixteen of Calomel and one of Tartar 
Emetic: mix them well together, and divide into eight pow- 
ders, of which, one in a little syrup is to be taken every two 
or three hours. The Calomel is to be omitted, if it excite 
purging, or if any salivation be apprehended. The sweating 
v power of Tartar Emetic in weak solution, is sometimes in- 
creased by adding a little Laudanum or Paregoric to each 
dose. Equal quantities of Spirit of Nitre and Antimonial 
Wine, also make an excellent compound. The dose is one, 
two, or three tea spoons full. 

Ipecacuanhae, in doses of one or two grains, repeated every two 
or three hours, is a valuable medicine to excite perspiration. 
Added to Opium, in fine powder, it is still more powerful; 
and in the celebrated Dover's Powder, in doses of about ten 
grains, is considered as one of the most invaluable medicines 
under this head: especially in cases of chronic rheumatism, 
where it is desirable to excite sweating. 

Cam/ihor, united to small quantities of Opium, Tartar, or Ipeca- 
cuanha, is a good medicine of this class. 

Volatile Salts, or carbonate of Ammonia, alone, in doses of ten 
grains; or added to strong Vinegar until it ceases to boil, (or 
effervesce,) forms the Sfiirit of Minder us: very celebrated for 
its tendency to excite sweating, in the fever following the 
common fall agues. The dose is a table spoon full every 
hour or two. 

Pleurisy, 1 

Seneka, and £ Roots, in strong decoctions, are also highly 

Virginia Snake -J 

valued for their sweating powers. They should be drank 



133 

■warm, and repeated at intervals. Mezereon, Sarsaparilla, 
Liquorice Root, and Savin, in decoctions separately or blend- 
ed, have a similar effect. The general rule for administering 
them, is to put an ounce in a quart of boiling water, and give 
a cup full every two or three hours. 

Powerful means of exciting perspiration will be found in the 
use of the Warm Bath or of Steam, as pointed out in the qualifi- 
cations of attendants on the sick; during the use of which, large 
draughts of warm water or weak teas should be freely taken.-— 
When perspiration is excited, the utmost caution should be ob- 
served to prevent its too sudden suppression by exposure to cold 
air, or clothes; and to prevent its Continuance too long, to endan- 
ger by weakness. 

10. ANTI-ACIDS AND ANTI-LITHICS. 

The medicines used to destroy acids in the stomach and bow- 
els, are called Anti-Acids. The same are used for preventing the 
formation of stones pr gravel in the kidneys and bladder, and are 
called Anti-Lithics; in consequence of which, I include them in 
this part together. 

Mild Potash and Soda, or these articles combined with fixed air, 
have an almost instantaneous effect in correcting the acids 
of the stomach; and when long used, are said to have a good 
effect on the kidneys. They may be given in weak solutions, 
or in the form of pills of four or five grains, on an empty 
stomach, three or four times a day. Mild lye, extracted from 
clean ashes, is a cheap substitute for these articles from the 
shops. * 

Soda TVater, as made and sold in the shops, is considered service- 
able in cases of gravel. 

Lime Water , made by putting one or two spoons full of newly 
slacked lime in a gallon of water, and kept covered, is 
esteemed for each of these qualities. The dose is a small 
tumbler full two or three times a day. 



I 



183 



Prepared Chalk. This is the common chalk reduced to fine pow- 
der, and mixed in a large quantity of water, which is to be 
stirred up and immediately poured off, for the Prepared 
Chalk to settle at the bottom: it has a like tendency, and the 
dose is two or three spoons full three or four times a day, 
mixed in a little water or milk. 

Uva Ursi, is a medicine which has no anti-acid qualities, but is 
given in affections of the kidneys, in doses of about thirty 
grains, three or four times a day. It is also used in infu- 
sion, drunk as tea, throughout the day. 



11. VERMIFUGE OR ANTHELMINTIC MEDICINES, 

Are the terms given to those which destroy or expel the worms 
of the bowels. Of this description, we may class all Purges of 
an active nature. 

Calomel is the most used of the kind. It should be given at night 
in large doses, and next morning be followed by a dose of 
Castor Oil or Salts. Its exhibition is generally requisite 
three or four times. 

Pink Root of Carolina. Tfiftflbse is from five to ten grains of 
the powder, or an ounce of it boiled in a quart of water; of 
which one or two table spoons full may be given every two 
or three hours. It is to be followed by a brisk purgative, 
after it has been taken three or four days. 



I 



Worm-Seed Oil, extracted from the seed of the Jerusalem oak: in 
doses of eight or ten drops, taken morning and night for three 
days, followed by a purgative. The particular directions for 
using it, will be found around the phials in which it is gene- 
rally sold. 

jfloeS) in repeated doses; also given in injections, when the worms 
are about the lower gut. 



134 f 

The Male Fern, in doses of from one to three drachms, is recom- 
mended in cases of tape-worm. 

Bitters, Peruvian Bark, and all the tonics, are used to destroy 
worms. 

Filings of Tin. Dose one or two drachms in syrup* 

Oil of Turpentine. Dose about one ounce, taken in the morning 
on an empty stomach. 



12. EXPECTORANTS 

Are medicines which facilitate the discharge of the mucus 
from the lungs. Most of the mucilaginous and sweet substances 
in common use, have more or less a tendency to produce this ef- 
fect: the chief of which are — Liquorice, Gum Arabic, Tea of Wa- 
ter-Mellon, Flax and Quince Seed, Iceland Moss, Elm Bark, fc^c.-— 
The effect of these medicines is always increased by adding to 
the mucilage they make, a little of Tartar Emetic, Of the same 
tendency will be found the common Candies, particularly the 
Hore-hound; Garlic Juice, made into a Syrup by sugar; common 
Syrup, to each dose of which add fouror five grains of Potash or 
Soda; a Syrup made of VrntgartSSffSguills; Seneka Snake Root 
Tea, well sweetened; Gum AmmoriiW} and, in short, many other 
articles, of which some of different kinds are recommended by 
each person whose experience happens to vary: especially Ofiium 
and its preparations — Laudanum and Paregoric. 

Inhalations of the vapour of Water, of Vinegar, of Spirit, of Ether,, 
and sometimes of Tobacco, are found useful. And I have 
frequently excited vomiting to produce the like effect, and 
with much success. 

13. EMMENAGOGUES. 

These are medicines supposed to promote the discharge of the 
Menses, or monthly evacuations of women. 



135 

Seneka Snake Root Tea, is highly recommended by Dr. Harts- 
horne, of Philadelphia; an ounce of the root in a pint of warm 
water, and boiled one-third away in a close vessel, makes a 
good form: of which two or three table spoons full, are to 
be taken as many times in the day — particularly about the 
expected period, when the dose may be increased. 

Savin, the leaves in powder, dose fifteen or twenty grains. 

Madder. In doses of twenty or thirty grains, was strongly re- 
commended by the late Professor Barton, of Philadelphia. 

Tincture of Gum Guaiacum, is recommended by Dr. Dewees, of 

Philadelphia. The dose is a desert spoon full in milk. 

» 

Ergot, or the spured and musty looking grains of Rye. The dose 
is ten grains twice a day, about the expected period of the 
return of the menses. 

Blisters about the small of the back. Frictions about the lower 
extremities; sitting in hot water at the expected period, are 
useful. 

14. DEMULCENTS 

Are medicines supposed to sheathe or cover parts in a state of 
irritation; as the mouth, throat, stomach and bowels, in a state of 
increased sensibility or soreness; Of this class are all the articles 
which are commonly known to make a mucilage with water, as 
Gum Arabic, and the Gums of our orchard trees; teas of Elm 
Bark; of the root of the Cat Tail of our marshes; Flax, Mellon, 
and Quince Seed, &c. &c. Oils of the mild kind have a similar 
effect; especially Olive Oil. 

15. ALTERATIVES 

Constitute a class of medicines supposed to change the general 
state of the whole system. The most remarkable of these are: 
Mercury, in its different preparations; strong teas of Sassafras, of 
Sarsaparilla, and of Mezereon; Sulphur, daily taken, Sec, 



136 # 

But the most effectual mode of changing the general state of 
the body, is to change all habits, to alter the diet, and seek new 
scenery, by travelling, &c. Sec. 

16. LOCAL REMEDIES. 

Notwithstanding the term applied to this class of medicines, 
some of them produce a powerful effect on the whole system; not 
the least of which may be ranked-— 

Spanish Flies, or the Potatoe Fly of this country, universally 
used for exciting blisters. The Fly should be very finely 
powdered, and mixed with equal quantities of Beeswax and 
Tallow, melted together, or with Tallow alone; and is to be 
spread on soft leather or thick linen — or the plaster may be 
spread with the Tallow, and the Flies sprinkled on it. In ca- 
ses where it would be injurious for the Flies to adhere to the 
skin, the plaster may be covered with thin gauze. An ounce 
of Flies in a quart of spirit, forms a good application to irri- 
tate the skin. 

Mustard Seed, reduced to powder, and mixed up into a paste with 
Vinegar, is also a common mode of irritating and blistering 
the skin. Applied to the soles of the feet, it forms the syna- 
fiisms so often used in low states of fever. 

Nitric-Acid, two parts with one of water, spread by a feather on 
the part, speedily destroys the skin, which can be rubbed off 
in a few minutes, and the raw part kept discharging by irri- 
tating ointments. 

Burgundy Pitch, spread on leather, and worn on the skin, makes 
a moderately stimulating plaster; improved by sprinkling on 
it a little of the dust of the Spanish Fly. 

Volatile Linament, made by mixing equal quantities of Spirit of 
Hartshorn and Olive Oil. 

Volatile Alkali, or Spirit of Hartshorne, is frequently used alone, 
to excite irritation on the surface. 



137 

A 

Spirit of Turpentine, 1 

Spirit of Camphor, £ Each makes valuable local irritants; 

Red Pepper in Spirit, * 

and they are often used to relieve rheumatic and other deep- 
seated pains. 

Tartar Emetic, twenty grains in a gill of water, with half a gill of 
Tincture of Spanish Flies; and common salt, with or without 
Red Pepper, answers a similar purpose. 

Tartar Emetic Plaster. This is sometimes used to blister or irri- 
tate the skin opposite the stomach, in hooping-cough; but is 
apt to be followed by deep and troublesome sores. 

17. OINTMENTS. 

That most generally used for common sores, is— 

Simple Ointment. It is designed merely to sheathe the parts and 
exclude the air. It is generally made by melting half a pint of 
Olive Oil with four ounces of Beeswax. But Suet alone, or 
mixed with equal quantities of hog's lard, will answer equal- 
ly well, as far as my observations have extended. 

Lead Ointment. This is used for sores of an inflammatory nature. 
It is made by pounding one drachm of Sugar of Lead very 
fine, and intimately rubbing it up with five or six ounces of 
hog's lard. 

Basilicum, or yellow Resin Ointment. This is used in common 
sores, requiring a little excitement. It is made by melting 
one ounce of Beeswax and the same quantity of yellow Resin, 
with an ounce and a half of hog's lard. 

Mercurial Ointment. This is a valuable application for affections 
of the skin — some old sores— and is much used to excite sali- 
vation. It is made by rubbing up one part of Quick-silvan- 
with its weight either of Suet or hog's lard, until the Mercu- 
R 



138 

ry entirely disappears; when three parts of hog's lard are to 
be added. This labour generally takes up three or four days 
for a pound of Quick-silver; but it will not take as many 
hours, if, instead of the first Lard or Suet, old rancid Mercu- 
rial Ointment be substituted, or there be added a little Rhu- 
barb or Turpentine to the mixture. 

Red Precipitate Ointment, made by rubbing up one drachm of 
powdered Precipitate with one ounce of hog's lard. 

Tar Ointment. Valuable for affections of the skin and scald head; 
made by melting together equal quantities of Tar and Suet, 

James Town Weed, makes a very valuable Ointment for piles and 
old sores. It is made by bruising the leaves of the Plant 
and stewing them in hog's lard, when it is to be strained.— 
The proportion is about one part of the leaf to one of lard t 

18. CAUSTICS 

Are frequently necessary to destroy the fungous of sores, or 
jiroud Jiesh, as it is vulgarly termed; and to stimulate them to 
greater action. That most commonly used in this country is— 

Burnt Alum. This is common Alum deprived of its water, by 
keeping it on a hot iron until it ceases to boil: it is then 
powdered and sprinkled on the sores. Powdered Rhubarb 
is a good substitute. 

Lunar Caustic. This article, obtained from the shops, is most 
used by Surgeons. Its application is very simple: the edge 
of it being slightly moistened, the sores are to be gently 
touched with it. 

Nitric Acid, to which is added one-third of water, is sometimes 
used successfully for those sores arising from the King's 
Evil, called Scrofula. When diluted freely with water, it is 
very commonly applied as a wash to destroy the worms or 
maggots of sores in warm weather. 



139 

Blue Vitriol. As much of it as any given quantity of water can 
dissolve, is frequently applied to old sores. 

Arsenic. Ten grains in an ounce of water, make a strong wash-— • 
delicately applied, sometimes with great benefit, to cancers 
and very foul old sores, by means of a fine hair-pencil, which 
is to be dipt in the solution. 

Corrosive Sublimate, three grains in an ounce of water, is a valua- 
ble wash in eruptions of the skin, and venereal sores. The 
same quantity, in an ounce of lime-water, makes a very cele- 
brated wash for old sores. 

These are the articles most generally employed by Surgeons; 
but there are many others — like ointments — daily made and varied 
to suit some real or supposed peculiarity in uncommon cases. 



Although I have thus mentioned many remedies, I hope you 
will not understand me as recommending them to general atten- 
tion. But few physicians ever have occasion for the half; and they 
are here stated only for those who possibly may find occasion for 
them. Annexed is a list of such as I think ought to be in every 
family of twenty or thirty persons, at least in every neighbour- 
hood. Any Apothecary will supply them at less than half the 
charges for the much inferior assortment generally sold in Medi- 
cal Chests. 

And I have to add the remark, that your great dependence for 
the cure of diseases should be on the most simple means; that 
you should give a decided preference to local, instead of general 
remedies, in most cases. For several years, I witnessed the prac- 
tice of the Physicians of Philadelphia, and have attentively ob- 
served that of several other .places: It has constantly struck me 
that the Philadelphia Physicians were rather more successful,—- 
not from having more skill, learning, or practice; but from their 
using more frequently local remedies, especially cupping, leeches, 
scarifications, issues, and blisters. It seems there to be the 
fashion to use freely such means of cure; and I have often lament- 
ed that the same facilities for doing it, as well as the same desire, 
was not to be found in every part of our country. 



140 

A LIST OF MEDICINES 

For a Family Medicine Chest. 



Ounces. 


Doses for Adults. 


Calomel, 


1, - 


Grains, 20 


Jalap, 


2, 


50 


Rhubarb, 


I, - 


50 


Magnesia, calcined, 


2, 


90 


Tartar Emetic, 


i 

2> 


(in broken doses,) 5 


Ipecacuanha, 


1 

2> 


20 


Aloes, 


1, * 


10 


Laudanum, 


4, 


forty drops. 


Paregoric, 


8, 


- four tea spoons full. 


Blistering Flies, 


4, (for plaster.) 




Camphor, 


4, 


Grains, 10 


Columbo Root, 


4, 


20 


Sugar Lead, 


1, (most used for wash,) - 2 


White Vitriol, 


1, (for an Emetic,) 


20 


Blue Vitriol, 


£, (ditto,) 


5 


Sal. Ammoniac, 


2, (for washes,) 




Vol. Alkali, 


2, 


10 


Salt of Tartar, 


1, - 


10 


Salution of Arsenic, 


1, 


five drops. 


Galls, 


1, (substitute Oak Bark,) 10 


Spirit Nitre, 


4, 


two tea spoons full. 


Ether, 


4, - 


ditto. 


Elixir Vitriol, 


4, enough to make 


\ a tumbler of water sour. 


Senna and Manna, 


8, each, 


one ounce. 


Sulphur, 


8, 


ditto. 



Chamomile Flowers, 8, (Tonic, in tea.) 
Peruvian Bark, 8, (ditto.) 

Salts, five pounds; and Cream of Tartar, one pound. 
Oil of Turpentine, and Spirit of Hartshorne, each one bottle. 
Castor Oil, and Olive Oil, each one bottle. 
Essence of Peppermint. 
Snake Root. 

Also a little Alum, Nitre, Corrosive Sublimate, Borax, Mercurial 
Ointment. - 



ADDEESS III. 



Particularly to Ladies, respecting themselves. 

It is from no selfish considerations that I entreat you to attend 
to the subject of this address. On your account, it has long been 
a subject of my sincerest and strongest solicitude. The prevail- 
ing ignorance about part of the information which it details, has 
indeed been the cause of much suffering, and many premature 
deaths among your sex. 

My design is to make you acquainted with the nature of the 
functions peculiar to your bodies; the offices you should perform 
to each other; and the treatment of the diseases to which you 
are liable. You can, with the utmost ease, understand the sub- 
ject: it is enveloped in no mystery; and requires no extraordina- 
ry exertion or talents — nothing but the common exercise of a 
common mind. Your bodies pass through certain stages — per- 
form certain offices: every body knows it; — and can you deem it 
at variance with delicacy, deliberately to investigate the detail, 
so as to qualify you to perform properly the duties which every 
one of you may have occasion to demand from another? 

By all you hold sacred and dear, I beseech you to qualify your- 
selves, at least, to assist each other in childbed. There is not 
one of you, from the most elevated to the lowest rank, who can 
be above the obligation to do it. There is not one of you who 
cannot render every needful assistance: For the simple process 
of childbearing is performed by your systems, not by attendants* 
hands; by the resources of nature, not by the powers of art. Look 
at the births of all animals, and behold how complete the unassist- 
ed operation. See the inhabitants of Asiatic and other hot coun- 
tries; of our savages and negroes: — they bring forth in seclusion 
and safety; nor with them is the fancied curse verified, " In sor- 
row shalt thou bring forth." Away, then, with all your fears on 
the subject: they are the offspring of folly, indulged from igno- 
rance, and propagated by designing persons, to profit from your 
error. A thousand times you are told of one irregularity in na- 



44£ 

thre, but seldom hear of her almost undeviating correctness in 
operating. A thousand times you dwell on the miseries of one 
sufferer, without thinking of the millions who happily and 
healthily pass the period of parturition. Away with your fore- 
bodings: Believe the truth, when pregnant, that, in all human 
probability, you will do perfectly well; that the most ordinary 
women can render you every needful assistance, without the in- 
terference of men midwives. Their hurry, their spirit for act- 
ing, have done the sex more harm than all the injudicious man- 
agement of midwives, of which they are so fond of talking.— 
This, t>r. Denman, Dr. Buchan, and many other really great phy- 
sicians, have long since remarked. 

If the difficulty of obtaining doctors at the proper time; if the 
indelicacy and tendency to immorality of having them in any but 
the critical and unnatural cases; if the propriety of giving to 
helpless women proper encouragement and support; if the salva- 
tion of many women, who, shocked at male interference, have 
their pains vanished, and minds deranged, and who sometimes 
prefer death to exposure; if the salvation of many children, born 
almost without warning; if the prevention of the destructive in- 
terference of some attendants, cannot, united, induce you to at- 
tend to this subject: the mechanical advantage between a man's 
and a delicate woman's hand, ought to command your decision 
in favour of employing and encouraging female assistants. Such 
is the limited organization of the parts for our birth, and such 
the large size of men's hands, that I verily believe as much mis- 
ehief as good has been done by them. I conclude with the re- 
marks, that when professional assistance becomes necessary, from 
unnatural occurrences, the case is altogether altered. The expo- 
sure is not of parts in a natural state, but deranged; the woman 
becomes a patient for his operation — is a subject of commisera- 
tion; and the solicitude to remove her danger and agonies is the 
only thought a man can have. In such cases, there ought not to 
be the least hesitation in the female to submit to examination; — 
there is no indelicacy in it. Religion and future usefulness, com- 
mand that life should be preserved even at the expense of the 
greatest sacrifices. The rule that I would prescribe to the females 
for whom I felt most affection and solicitude would be that which 
I now urge, on no account to submit to the interference of men in 



14& 

common labour; do it most readily in the uncommon cases, when 
a nurse under the direction of a physician cannot afford relief. — I 
will venture to add, that there is not a physician, disinterested, of 
sound sense, who would not approve of the rule. The best au- 
thors on midwifery decidedly recommend it. 

An acquaintance with the subject will enable you to be of ser- 
vice to more than those in childbearingr The rational treatment 
of your own peculiar disorders, often so injudiciously conducted; 
the prevention and cure of children's complaints, so interesting 
to every woman of extended feeling, are taken into consideration; 
subjects well worthy of your serious attention. If no other bene- 
fit can be derived, but that of preventing the administration of 
improper doses, it will not be inconsiderable. Many disorders 
are riveted in you, and especially in children's constitutions, by 
taking articles contrary to the indication for cure. So many of 
you are inclined to believe in stories of cures from the prescrip- 
tions of common people, that it is an important point to impress 
on your minds, that our bodies are subject to laws; our diseases 
to be cured according to principles. If you will seriously believe 
this, will believe that medicine is a rational science; you will in- 
crease the respectability of the profession, and your own safety, 
by always selecting for your physician the man of sound mind, 
who reads the books of his profession, instead of the pliant, fini- 
cal " lady's doctor." You will discover that your diseases are to 
be prevented and cured, not by the compounded trash of apothe- 
cary shops, but chiefly by the rational use of what is plentifully 
in our power. 

ORGANS OF GENERATION. 

It is proper, in order to illustrate this subject, to give a descrip- 
tion of the parts concerned in birth. It is not my design to at- 
tempt making more than such a general statement as will enable 
you to think and speak with tolerable accuracy of them. I have 
witnessed so many groundless fears, so many dreadful forebodings 
on the slightest appearance of disease in this region, that I feel 
confident you will be greatly benefited by a more correct know- 
ledge of it. To make you certain that the parts are like all others 
of the body: have nothing of a wonderful nature about them, and 



144 . 

require for the treatment of their diseases, the exertion only, of 
common sense, is no inconsiderable object. 

In describing them, it is customary to do it under the divisions 
of HARD PARTS, meaning the bones, and SOFT PARTS, in- 
cluding the external and internal. 

The bones immediately concerned in generation are those form- 
ing the circle around our bodies, about the hips, collectively call- 
ed the pelvis, a name you may readily remember. This pelvis is 
formed by the union of separate bones, of which you should par- 
ticularly remember the end of the back bone, called sacrum. — 
This bone turning round, as it were, our rumps, forms a conside- 
rable curve and hollow. The end of this sacred bone, or sacrum, 
is called os coccygis; which is so joined as to move a little back- 
wards and outwards at births; particularly among those who 
marry late, it sometimes makes a noise in moving. The sacrum 
is connected to the hip bone on each side (called os ilium,) and 
these hip bones unite to a bone on each side towards our front, 
called os pubis. Each os pubis unites in the centre to each other, 
and form what is called the symphisis, or union of the pubes or 
front bones. This union has attracted more attention than any 
other of the pelvis, because it is sometimes defective after child- 
bearing; and sometimes it has been divided to facilitate the pas- 
sage of the child's head; a practice which experience has proved 
to be improper. In women of small pelvis, where these parts 
have- been strained at birth, there is great weakness; in some ca- 
ses, impossibility of walking. There is no remedy for this mis- 
fortune but rest, and a tight bandage around the hips, so as to 
compress them together. 

All the hard names you have to remember -on the subject of 
these bones are, the pelvis, meaning the bones around our hips 
collectively; then the sacrum, or end of the back bone, with its 
end called os coccygis; then the pubes in front. With the os ilium, 
or hip bone, and the os ischium, or haunch bone, connected to it, on 
which we rest while sitting, you need not trouble your memories. 

The female pelvis is larger than that of males. It has been 
compared to a basin, without bottom, one side much narrower 
than the other. In front it is much more shallow than at the 
back, which, as before observed, is formed by the back bone, call- 
ed at this end, os sacrum. 



145 

The pelvis is considerably wider from hip to hip, above, that 
is, at its upper edge towards our head, than below. This upper 
part is called its upper brim, and measures from side to side, or 
hip to hip, from four to near six inches, in those of the largest 
size; from front to back, it measures from about three inches to 
near five. But at the bottom of the pelvis, when the child's head 
passes out from the bones called the lower brim, these dimensions 
change, and are reversed; so that the widest part of the lower 
brim is from front to back, instead of from side to side, as at the 
upper brim. Understanding this, and knowing the dimensions 
of a child's head, narrowest from ear to ear, and knowing that 
nature 'always performs her business in the wisest manner, you 
could at once tell how a child's head passes through this opening 
at natural births. But the pelvis is subject to deformities, as 
well as irregularities in its dimensions. These deformities are 
common in manufacturing countries, as in England and France; 
but very rare in those countries where the people are not cramp- 
ed up, as in the United States. The chief deformity is the pro- 
jection forwards of the back bone, so as to come nearer the pubes 
in front, and obstruct the passage of the child. The extent of 
the obstruction produced by projection of the sacrum on a living 
subject, is difficult to be ascertained; but an idea of sufficient ac- 
curacy for practical purposes may be formed, by pushing the 
fore finger up the birth-place, in -front, close to the pubes, then 
moving it backwards to the projecting part of the sacrum. The 
distance the finger goes before it reaches the back part or sacrum, 
will give you the capacity of the pelvis. The actual distance the 
finger moves must be conjectured. 

In order to end the dry subject of bones, I will mention those 
of the child's head proper to be attended to. The head is long- 
est from the front to the back part, which back part is called the 
erown of the head; so that when the chin rests on the neck, as at 
birth, it forms a kind of cone, of which you can have an idea by 
half bending the thumb and fingers, and drawing their ends to a 
point together. From ear to ear, the child's head is generally 
about three inches; and being longer from the forehead back- 
wards, and adapting itself to the most favourable dimensions of 
the mother, it will pass out the upper part of the pelvis, with the 
ears at the side of the front and back bones; and turning one 
S 



146 

quarter round, as it descends to the lower brim of the pelvis, the 
ears would pass each at each side or hip of the mother, because 
that part is narrower than the upper. The skull is made of seve- 
ral bones, connected together by seams called sutures, which in 
infancy have their edges very soft, and yielding to allow compres- 
sion at birth. These seams or sutures run across from the front 
to the crown-bone; and from near each temple, and also from be- 
hind each ear, an inch or two, up to the upper seam: at their 
meeting in front, above the forehead, they form a four-sided open- 
ing, called front or square fontanelle: at their meeting on the crown 
of the head, they form a three-sided or triangular opening, called 
back fontanelle. To remember this difference in the two open- 
ings in the skull, the front with four sides and the back with 
three sides, is very important to enable one to distinguish the 
presenting part of the head, in tedious or difficult labours. The 
bones forming the child's head, which you ought to remember, are 
the bone of the forehead, called frontal bone, and the bone oppo- 
site, backwards, called the occiput or crown. The temple bones, 
at each side of the ears, and the bones forming the remaining 
sides of the head, called parietal bones, are not necessary for you 
to remember. It is the crown bone, or occiput, that presents in 
the best cases of births, and consequently the lesser, or back fon- 
tanelle, is always felt, with its triangular or three-sided edges. 

The formation of the head of the infant, is one of the master 
works of nature. As before observed, the edges of the bones are 
very soft, of a somewhat gristly nature, readily yielding to com- 
pression; the edge of one side passing over that of the other, so 
as to favour the variation of the shape of the skull, to suit the 
opening it has to pass. It is worthy of remembrance, that so 
singularly pliable is the infantile head, so strong are the expelling 
powers of the womb, that in cases of deformity of pelvis, the 
head has passed through an orifice not exceeding two inches from 
front to back. 

After taking into view the formation of the child's head, and 
the formation of the pelvis, it must readily appear, as nature al- 
ways operates wisely, that the one ought to pass in the manner 
best suited to the form of the other. Accordingly, in natural ca- 
ses, it is precisely so. The head enters the upper part of the 
pelvis, called the upper brim, with the ears to the front and back 



147 

bone of the mother; then passing along, it twists one quarter 
around, so that in making its escape, at the lower brim or edge 
of the pelvis, the ears are from hip to hip; the face, of course, to- 
wards the back. No female of reasonable mind, seeing such dis- 
play of provision for the birth of the young, ought to indulge in 
fears of her delivery; probably more destructive in their tenden- 
cy than the greatest irregularities of nature. 



EXTERNAL PARTS OF GENERATION. 

The parts next to be described are the soft parts, as exhibited 
externally. The front view exhibits to the eye the fatty elevation 
on the pubes, called the mons veneris, with its crown of hair. — 
This mass divides, one half running down each side, forming 
something like lips, and called the labiae; at the bottom, these 
lips unite again, and exhibit a kind of sheet, called perineum, 
about an inch long, which disappears about the fundament, or 
anus. 

Upon opening these labiae or lips, the first conspicuous part 
above is a small elevation, or rising, called clitoris, the seat of 
pleasure in the sexual intercourse between the sexes. In some 
it is of very small size, scarcely perceptible; in other cases, very 
conspicuous. There are numerous glands around this, secreting 
a cheesy, odorous substance, which, unless washed off, irritates 
the clitoris, and excites venereal desires. Directly under this 
clitoris, is a small orifice, leading through a canal to the bladder, 
through which the urine passes. 

Beneath the uretha, in some virgins, is seen a thin membrane, 
called hymen. In the first sexual connexion, it is rent asunder, 
and appears in ragged edges each side. Some virgins have had 
this membrane so compactly formed, as to prevent the passage of 
the menses, so that they have collected in the womb, and produc- 
ed a distension like that of pregnancy. The remedy is to make 
a small puncture with a lancet, and allow the confined matter to 
pass. In many, this membrane does not exist; it therefore 
forms no certain evidence, when it is absent, that the woman is 
not a maid. When the hymen is destroyed, and the lips being 
opened, we have the entrance to the womb, called vagina, or b? th- 



448 



place, which is narrowest in virgins. With this brief sketch of 
the parts exterior, I proceed to mention those within. 

INTERNAL PARTS. 

As before remarked, the first orifice is that of the canal for the 
passage of the urine. Around its edge it has a small or slight 
elevation, which it is proper to remember as a guide for an ope- 
ration which will presently be mentioned.. This orifice conducts 
through a canal to the bladder, which is seated immediately be- 
hind the front bones or pubes; and it is this channel which is 
called the uretha. It is wider than a large goose quill, and is 
from two to three inches in length. 

INTRODUCTION OF CATHETER. 

The uretha, or canal to the bladder, is subject to considerable 
disease; sometimes to obstruction, preventing the discharge of the 
urine. There is no complaint to which females are subject, more 
manageable among themselves, and consequently which they 
ought to attend to with more earnestness; and the knowledge ne- 
cessary is of such easy acquisition, the performances so simple, 
that much attention is scarcely necessary. Nevertheless, this 
littie knowledge, this little ability to perform, has been so neglect? 
ed, that not oniy innumerable females have had to exhibit them- 
selves to men, but many of them have actually expired, from want 
of some one to draw oft* their urine, by means of a little tube, call- 
ed u a catheter," corresponding nearly in shape to a goose quill, 
Which has sometimes proved a convenient substitute. 

And what is the operation of introducing the catheter, to evacu- 
ate the urine? The bladder containing the urine, is immediately 
behind the bones in front, called the pubes; the canal to it is di- 
rect — not three inches long. The instrument, the catheter, as a 
quill, is adapted to the size, and the woman laying on her back, 
finding the entrance, and pushing it backwards and upwards, 
pushing it gently in the direction where least resistance is made, 
can readily introduce it into herself for the flow of the urine. — If 
there be too much sickness for a woman to perform the operation 
on herself, her associate, her nurse, her servant can do it. The 



149 

catheter is to be greased with the mildest oil; the patient laying 
on her back, it is pushed most slowly and gently into the bladder: 
it is to be held between two fingers, and may occasionally be rolled 
around. The uretha makes some resistance, particularly at its 
entrance in the bladder, which is to be overcome with patience 
and gentleness, not violence. 

In cases of pregnancy, the uretha is compressed by the head of 
the child, and the best catheter is an elastic or compressible one, 
which will yield, or adapt itself to the part it has to enter. You 
should remember, if it be impossible for you to procure a cathe- 
ter, and consequently have to use a goose quill for a catheter, it 
should be so tied or connected, as to prevent its entire entrance 
into the bladder, where it has sometimes passed, and exposed the 
patient to the necessity of a dreadful operation for its extraction. 
The common catheters have a handle, to prevent this accident.-— 
I suppose it is scarcely necessary to mention, that, on introducing 
the catheter, you should have a pot or basin, to let the urine flow 
into. Where it is to be introduced, and the patient cannot dis- 
charge the water afterwards without aid, it should be introduced 
twice or three times every day. 

Dr. Bard thus writes on this subject: " Introducing the cathe- 
ter, in the female, when the midwife is properly acquainted with 
the situation of the orifice, and the direction of the urinary canal, 
is an operation of little more difficulty than administering a clys- 
ter; except where certain obstacles occur, which are to be over- 
come, more by patience and gently repeated attempts, than by 
any remarkable skill. From motives of delicacy alone, this easy 
operation ought to be in the hands of women; but what is of much 
more consequence is, that if a man is to be sent for every time it 
may be necessary to perform it, it will generally be neglected too 
long, particularly in the country; to the very great injury, and in 
some instances, danger of the patient. The orifice of the ure- 
tha, or urinary canal, is situated under the arch of the pubes or 
share bones, and the canal, making a slight curve, ascends very 
little, and enters the bladder almost immediately behind it: it is 
not above one inch and a half long, so large as to admit a cathe- 
ter of the size of a goose-quill, and so little curved that a straight 
instrument is by some preferred. Having discovered the orifice, 
the operator, standing or sitting on the right side of the patient, 



150 

and holding the instrument in the right hand, with the hollow of 
the curve towards the patient, is to introduce it; directing the 
point at first a little downwards and backwards, when, gently de- 
pressing the hand, raise the point a little upwards and forwards? 
it will almost immediately enter the bladder, and the urine will 
flow from its extremity. If, however, some little difficulty should 
occur, patience, and gently moving the hand from side to side, or 
upwards and downwards, will overcome it with very little or no 
force, and with little pain to the patient. At any rate, force is ne- 
ver to be used; it is better to desist, and make a second or a third 
attempt; for whenever any difficulty presents, it is owing to cir- 
cumstances not to be overcome by violence, which can never do 
good, but may do infinite mischief. In some cases it is best to 
put the instrument, when introduced into the orifice, into the 
hand of the patient, who, directed by her own feelings, will some- 
times succeed more easily than any other person: a caution, how- 
ever, necessary to be observed respecting the use of the catheter, 
is not to introduce it unnecessarily; or before such remedies as 
warm bathing, fomentations, a clyster, soothing mucilaginous 
drink, have been tried: because, when it has once been introduc- 
ed, it is frequently found necessary to repeat the operation, from 
the increased sensibility it induces on the uretha and neck of the 
bladder." 

It is proper in this place to remind you, that there are many 
temporary suppressions of urine, not requiring the introduction 
of the catheter. A purge of salts or cream of tartar, will gene- 
rally relieve effectually, as also sitting in the warm bath. Such is 
the habit of urinating at the time of evacuating the bowels, that 
it is seldom the bowels are opened in these temporary suppres- 
sions, without relief to the bladder. Your rule for introducing 
the catheter, should be generally when the bladder is painful, or 
when it may be felt over the pubes or front bones; and when, by 
introducing the finger up the birth-place, you feel the bladder en- 
larged. In many cases of fever, there is no secretion of urine for 
a day or two, sometimes longer: it is useless in these cases to in- 
dulge in the least fear or uneasiness. 

The second internal part below the urinary canal, is called the 
vagina, or birth-place. At the age of puberty, and before copula- 
tion, it is from two and a half to three inches long, and rather 



151 

more than an inch in width. Its internal surface is lined with 
glands which secrete considerable quantities of mucus, particular- 
ly during connection with the male, and when excited to action, as 
in the disease called whites. 

The birth-place, or vagina, receives into it the mouth of the 
womb, the edges or lips of which project forwards; so that they 
may be felt, before its connection with the vagina. It has been 
compared to the inverted finger of a glove. This projection of 
the mouth of the womb into the birth-place should be understood 
by mid wives, as it is from its feel that the existence of labour, is 
certainly ascertained. This mouth of the womb is called, ridicu- 
lously enough, os internum, and os tincae; but you will better un- 
derstand it, by calling it the mouth of the womb. 

The bladder is nearest the front bones: the womb is next to it, 
and before the end gut, or rectum, which is bent and attached to 
the curve or end of the back bone. It is called the uterus; it is of 
the size of a common oblong pear; the largest part being up- 
wards, or towards the stomach. It is divided into neck, sides 
and bottom, or fundus. The small part, commencing at its 
mouth, is the neck; this disappears in its round sides; and lastly, 
the largest upper part, called the fundus; to which the after-birth 
is generally attached. 

The womb is a very fibrous mass of considerable thickness.—- 
It is the receiver of what forms the child. It is of such a nature, 
that it enlarges, and grows to the enormous size for containing 
the child and its appendages; nevertheless, always retaining the 
same thickness of its sides. It is by the contraction of these 
fibres that the contents are expelled. It receives large quantities 
of blood, and secretes the discharge called the menses. 

The womb is suspended, from each side of the pelvis, by a 
membrane, which allow§ it to float about considerably. Attach- 
ed to the two opposite sides of it, is a small fleshy tube, extend- 
ing near three inches, called the fallofiian tubes. These tubes 
terminate in a ragged kind of edge. To each side of the pelvis, 
is a small mass of the size of a large bean, called the ovarise, or 
female testicles, as they supply the seed the woman yields at im- 
pregnation. They have little reservoirs, like small blisters, and 
at every conception one of these bursts, and gives up its contents, 
leaving something of a scar in its place. By cutting these out, 



15$ 

as in the spaying of hogs, the animal is deprived of the power of 
conception. From these circumstances, it has been settled, that 
in successful copulation, these floating, moving fallopian tubes, 
all stimulated by the seed of the male, have their ragged edges 
attached to the ovariae, take up the contents of one of the little 
bladders, and carry it to the womb for its development and 
growth. 

FALLING DOWN OF THE WOMB. 

Having fully familiarized your mind to the relative situation 
of these parts, you will be better qualified to understand the na- 
ture of the affections of the womb. It is connected to your sides 
by a membrane at each side of the womb. Now, this membrane 
is liable to extension, particularly when an ignorant midwife is 
allowed by ignorant by-standers, to pull the after-birth away. — 
This is called the falling down of the womb. Its mouth contin- 
ues to sink through the birth-place, till it protrudes out; a most 
lamentable affliction, since the remedies are but partial, often fail- 
ing. They consist in bathing the parts well in cold water, gent- 
ly pushing back the womb, and putting up the birth-place a lit- 
tle, oval, oblong ball, called a pessary. This may be made of 
bees' wax, of sponge, silver, bone, or ivory, which you may get 
from the apothecaries, if you do not choose to make it yourselves. 
You push it up the vagina while lying on your back, and retain it 
there by a bandage around, as in wearing diapers. It may be tak- 
en out at night after laying down; but must be pushed up in the 
morning before rising. Cold water poured around the hips every 
morning, will tend to expedite the retraction or cure, which in 
some cases has been perfectly effected by perseverance in the use 
of the pessary, or long, round body, worti in the birth-place, to 
support the falling womb. 

FALLING BACKWARDS OF WOMB. 

The next affection of the womb I wish you to understand, is 
what has been termed its retroversion, or falling backwards. — 
This takes place in the early stages of pregnancy, when, after the 
enlargement of the womb, particularly on retaining the urine, 



153 

sometimes from a blow, kick of a child's foot, and the like, above 
the pelvis, the bottom of the womb is thrown backwards against 
the strait gut, so that its mouth is turned upwards. This press- 
es on the neck of the bladder, and, preventing the evacuation of 
urine, increases the derangement by consequent distension. The 
treatment for this accident is very simple: be sure first to draw 
oif the urine with a catheter; give a clyster to open the lowep 
bowels; then let the woman rest on her feet and head, or elbows. 
In this situation, push the finger, well greased, up the fundament, 
and you will feel the ball formed by the womb, which you are to 
push upwards. You may also have a finger up the vagina, and 
it is scarcely possible, by gently raising the womb with each fin- 
ger towards its natural place, that you can fail of success. On 
its restoration, the woman should be quiet for a week or two, 
and be cautipus of exposure to the causes, particularly to void 
her urine very often. In some cases of this inversion, there is 
only a difficulty in discharging the urine, which, as the womb en- 
larges, increases. In every such case, you must evacuate the 
urine, and resort immediately to the pushing back the womb, as 
directed. Dr. Denman remarks, that it is the middle class in so» 
ciety who are most subject to this complaint: the highest and 
lowest are not ashamed to walk out and evacuate their urine the 
moment they desire it. The middle class are so modest, so 
ashamed, at the suspicion they wish to urinate, that they sit, the 
bladder distending till it inverts or turns over the bottom of the 
womb. There is no caution which a married woman ought to 
bear in mind more constantly, than that it is very injurious to re- 
tain her urine. 

INVERSION OF WOMB. 

The last derangement of the womb I shall mention, is one that 
very seldom occurs. It is when the inside of the womb is turned 
directly outwards, and protrudes out of the birth-place as a bag 
or bladder, immediately after a delivery. The cause of this is 
overstraining at delivery, but mostly violence in pulling away 
the after-birth, for which any midwife ought to be punished.—* 
The remedy is, to reduce the patient by blood-letting, if not pre- 
viously enough reduced; to foment and bathe the womb, so as to 
T 



reduce the inflammation, that it may be replaced. To do this, 
hold the mass grasped in one hand; with the fore-linger of the 
other, push back the bottom, as if you wanted to push in a blad- 
der, so as to be inside out; continue gently pushing till the inver- 
sion is effected, and then the whole with a finger may be pushed 
up the vagina, to its natural situation. A medical man ought to 
attend to the patient's health: she carefully avoiding sneezing, 
bearing down, and the like causes of relapse. 

DROPSY OF OVARIJE; 

The next disease I shall mention of the internal parts of gene- 
ration, is a dropsy of the ovarise, or female testicle, commencing 
with a small swelling in either side, gradually enlarging till the 
belly becomes immensely distended. The best treatment is to 
let it alone; as the melancholy truth has been discovered, that no 
cure can be effected by medicine. Sometimes it has been known 
to burst in the womb, discharging all its contents through it, so 
as to relieve the patient. Opening the side to evacuate the con- 
tents, has seldom done service. All the useful that can be urged 
on this subject is, that, as there are strong reasons for believing 
the cGmplaint arises from blows or bruises about and above the 
groin and pubes; females should be careful to avoid themu 



MENSES. 

I commence this subject with the remark, that you generally 
err in attaching so much importance to the periodical discharge, 
called courses or menses; and in thinking so much of it on the 
approach of diseases. The apprehensions on this subject, amount- 
ing to excessive anguish, which annoy so many women, are ground- 
less. It is not material whether it be great or inconsiderable, 
regular or irregular, early or late in its appearance. 

The following history of this evacuation from the womb, is 
from Dr. Denman: At whatever time of life this discharge comes 
on, a woman is said to be at puberty, though of this it is a conse- 
quence, not a cause. The early or late appearance of the menses 
aaay depend upon the climate, the constitution, the delicacy or 



hardships of living-, and upon the manners, as hinted by Rousseau 
of those with whom young women associate. Heat appears to 
operate on women as on fruit, producing- earlier ripeness; as the 
warmer the climate, the sooner the menses appear. In Greece,, 
and other hot countries, girls begin to menstruate at eight, 
nine, and ten years of age; but advancing north, there is a grad- 
ual protraction of the time, till we come to Lapland, where men- 
struation does not occur till a maturer age T then in small; quanti- 
ties, at long intervals, and sometimes only in the summer. 

In hot climates, women are in the prime of their beauty when 
they are children in understanding; and when their understand- 
ings grow to maturity, they cease to be objects of love. In tem- 
perate climates, their persons and minds arrive at maturity at 
the same time; and by the united power of their beauty and in- 
tellect, they become irresistible. 

Some girls begin to menstruate without any preceding indispo- 
sition; but generally there are appearances or symptoms, indi- 
cating that it is about to take place. These are usually more se- 
vere at the first, than in the succeeding periods: pains in the back 
and inferior extremities, affections of the abdomen, with hysteric 
and nervous affections. These commence with the first disposi- 
tion to menstruate, and continue till the discharge comes on ? 
when they abate or disappear. 

The quantity of bloody secretion discharged at each evacua- 
tion depends on climate, constitution, and manner of living; but 
it varies in different women in the same state, and in the same 
women at different times. In hot countries, it is near twenty 
ounces; in the coldest, about two ounces. There is also a differ- 
ence in the time required for the completion of the discharge.-— 
In some it returns precisely at stated periods; in others there is 
a variation of several days. In some it continues but for a few 
hours, in others for ten days; but from three to six days is the 
most usual period. 

At the approach of old age, menstruation ceases, the time de- 
pending on the time of its appearance; that is, early or late, as it 
occurred in each case. When it took place at the age of ten or 
twelve* it ends about the fortieth year; when about the twentieth, 
it continues till about the fiftieth, sometimes till the sixtieth year: 
but in middle temperate countries, the period of its cessation is 



156 

the forty-fifth year. By this constitution of women, the propaga- 
tion of our species is happily confined to the most vigorous part 
of life. 

The discharge is a secretion coming from the vessels of the 
tvomb, and ceases when impregnation takes place. Sometimes 
it is confounded with periodical evacuations of blood from those 
parts, often from the vagina, and erroneously has been supposed 
to occur occasionally during pregnancy. Of the cause of the 
discharge it can only be said, it appears to be a provision of na- 
ture to accustom the womb to great discharges, preparing it for 
the supply of the substance constituting the body of the child. 

During this evacuation, women ought to be as quiet as practi- 
cable. They should be, at this time, extremely cleanly. The 
statement by Moses of what he supposed the Lord said, "wo- 
men should not touch any thing after this issue for six or seven 
days," was designed to ensure greater attention to cleanliness. — 
Morning and night they should sit in a tub of warm water a few 
minutes, for effectual washing. The common prejudice against 
the use of warm water in this state should be disregarded, as it is 
not only of no injury to the general health, but is of real service 
in lessening the irritability of the part. The diet ought to be 
father less than common, in quantity and quality. Sudden expo- 
sure to cold, rain, and alarms, should be avoided, though fro 
quently encountered without injury. 

The womb from whence the menses come is subject to great 
Varieties of diseased action; and it is a subject of remark and as- 
tonishment, how much the stomach, head and pulse, sympathise 
on such occasions. There are almost always symptoms of hyste- 
ria, despondence, sickness at stomach, and low pulse. The chief 
varieties of its diseased action are classed under the heads of ex- 
cessive, obstructed, and suppressed menstruation. Most women 
occasionally are affected with different degrees of these varieties. 
Considering their habits of living, so contrary to the activity for 
Which they were formed, it is astonishing they do not more se- 
verely suffer. 

The remedy for these affections is generally sought for in phy- 
sic, but most erroneously. There are no diseases you are subject 
to, not more under the control of medicine; yet none more easi- 
ly prevented and relieved by the exercise of common sense, in at? 



157 

tention to habits. Like all animals breathing much air and ea& 
ing freely, women were made for exertion, their fluids for constant 
circulation. Each part must expend by exertion so much of its 
irritability, or disease will appear. Among the Indians and la- 
bouring class of women, there are but few if any cases of this 
disease. This alone should be sufficient to induce all subject to 
these complaints to seek relief in imitating the diet, exercise, 
and habits of those who live agreeably to nature. 

EXCESSIVE MENSTRUATION* 

The first variety mentioned of the diseases of menstruation, 
was excessive discharge. This is usually greatest in robust wo- 
men, of indolent habits. In some it is profuse at once; in others 
it continues for several days, reducing the system greatly, to ex- 
treme weakness. In this disease there is too great determination 
of blood to the womb, too much action in its vessels. The reme- 
dy is the dictate of common sense — equalize the action. This is 
to be done in persons very full of blood, — to be determined by the 
pulse, or the feverish state of the system, — by blood-letting, by 
purging with salts, oil, or magnesia; and by exciting action in 
other parts of the body. During the discharge, the patient should 
keep cool in bed, the hips a little elevated; abundance of cool, 
fresh air to be admitted in her apartment. A vomit of ten or 
twelve grains of ipecacuanhae, or a grain of tartar emetic, may 
be given every half hour, until the stomach is fully excited.— 
When the discharge of blood is profuse, there should not be the 
least hesitation in introducing up the birth-place cold water, by 
injecting it with a syringe or any common squirt, or by pushing- 
up wet cloths. Sitting in a tub of cold water, will often answer; 
an injection of sugar of lead water (a tea spoonfull of lead to a 
pint of water) is a more certain remedy, but it should not be 
tried till the other prescriptions fail. In moderate cases, wet 
cloths from cold water, or ice in a bag, applied to the belly, will 
afford relief. When the blood flows in an alarming quantity, it 
is by all means necessary to prevent its passage, by stuffing cloths 
up the birth-place. Bleeding from the arm, the patient sitting 
up to favour fainting, should always be done, if the patient be not 
already too much reduced. Two grains of sugar of lead, with a 



158 

quarter of a grain, or not, of opium, may be administered every 
two hours, until the discharge of blood is reduced. After this, a 
purge should be given to carry off any remains of the medicine 
in the bowels. In common cases, simply purging, keeping coot 
on a sofa, avoiding all stimulating diet or drinks, is all that is 
requisite during the discharge. 

But the. great object is to prevent returns of this excessive dis= 
charge. The only effectual means for prevention will be found 
in attention to the general health. In addition, I would urge 
every woman subject to it, to revolutionize her habits, to spend 
her time between the discharges very different from formerlyy 
taking different exercise, diet and drink; particularly exciting a 
powerful action on her skin by frictions, by coarse applications, 
by cold and salt bath, and by blisters. About the time for the 
return, she should lose blood, particularly if of a full habit of bo- 
dy. She should devote unusual attention to her daily evacuation* 
from the bowels, sitting daily in cold water, and to relieving her 
mouth from the irritation of rotten teeth. It has been suggested 
by a respectable physician, to cup the breasts, with a view to ex- 
cite such a determination to them as would divert from the 
womb, 

But I have no hesitation in recommending, as of far superior 
importance, the excitement of the breasts to the secretion of 
milk. The means of doing this will be particularly explained 
when on the subject of barrenness, to which I refer. The dis- 
charge being excited, I would advise it to be continued daily for 
two or three months, and in all probability it will relieve the de- 
termination to the womb causing its excessive bleedings, at least, 
the more certainly, if aided by attention to the first advice. I 
have repeatedly successfully treated this complaint, by having 
the breasts excited to secrete milk. 

OBSTRUCTED AND PAINFUL MENSTRUATION. 

Unmarried women are most subject to this disease. The va- 
riations of it are from total to partial suppression; attended with 
little or great pain, and often marked by affections in the other 
parts of the system, from sympathy, analogous to those charac- 
terising the pregnant state. 



159 

When menstruation first takes place, it is usually attended with 
pain, head-ache, and feverish symptoms. These generally go off 
without requiring any particular treatment. But when they are 
considerable, or the person delicate, it is best to favour the evacu- 
ation, by sitting in a tub of warm water; this may be continued 
for hours when the pain or irritation is great. Dipping the feet 
in as hot water as can be endured, or in strong lye, or lime water, 
as is done for curing whitlow, or inflammation of the finger, will 
prove of service. It is not designed for the purpose of exciting 
perspiration, but to produce a scorching, or sense of burning, 
which will increase the determination to the lower parts. Wheu 
■the pains of the patient are considerable, blood shoufd be taken 
from the arm, and sweet oil be applied all around the belly and 
small of the back- 
More serious attention is necessary in cases where the dis- 
charge is suppressed after it has taken place. Strong passions 
of the mind, and exposure to cold during the menstrual period, 
frequently check the evacuation, which is followed by fever, by 
inflammation of the womb, and its attendant symptoms, pains in 
the neighbourhood, sick stomach, head-ache, and general appear- 
ances of fever. In every such case, it is proper that the patient 
should immediately sit in a tub of hot water, go to bed, take a 
purgative, and lose a little blood. 

When the evacuation is obstructed for a length of time, more 
■serious disorders ensue; " indigestion, sickness, variable appetite, 
heart-burn, distension of bowels, head-ache, palpitations, and ma- 
ny hysterical symptoms. Sometimes the face becomes pale, the 
eyes sunk, the bowels costive, pulse contracted and irregular, 
tongue foul, feet swelled, belly tumid, appetite diminished, crav- 
ing of chalk, or indigestible food, the sleep interrupted." 

In order to bring on a return of the menses, it is of the great- 
est importance to attend to the time when they should take place, 
as then the greatest efforts are to be made. The patient should 
have a small blister applied about a day or two before the time, 
between the fundament and birth-place, called perineum. A pur- 
gative should at the same time be given, of four or five grains of 
aloes; to be repeated twice or three times. Tl\e next advice to 
be observed is, to sit in a tub of as hot water as can be endured, 
suddenly getting in and out of it In a greater degree, the feet 



160 

should be scalded. Sometimes blisters applied to the ankles for 
three or four hours to redden the skin, have afforded relief; as 
also to the lower part of the belly, or to the small of the back. 

If these remedies do not succeed, it is proper, in addition to 
their use, to inject in the vagina a mixture of strong brandy and 
water, as hot as can be borne, or of any thing else that will slight- 
ly irritate and inflame the parts, such as vinegar, wine, strong 
brine, and the like. The more the patient at the expected time 
moves about, by walking, riding, or jumping, the better. Elec- 
tricity, used by drawing sparks from the thighs and neighbour- 
hood, has been stated to be serviceable in many cases. Ligatures 
or bandages, tied around the thighs, so as to compress the veins 
and not the arteries, a day or two previous, is also a remedy well 
worthy of trial; they are only to be continued an hour or two at a 
time, till the blood collecting in the legs, they are to be removed. 
The momentary distension produced, tends to excite a new and 
increased action in the lower parts, and thereby relieves the dis- 
ease of the womb. 

It is often of service to lose a little blood, even if the general 
health be good; also when there is reason to believe the least fe- 
ver exists. The change produced by this evacuation, tends to 
favour the return of the womb to its natural action, which is to be 
encouraged by using the medicines recommended for the purpose 
under the head of Emenagogues, to which I refer you. It is best 
to give each a fair trial, commencing with the best, the Seneka 
snake root, as recommended by Dr. Hartshorne. 

In guarding against this complaint, the health of the constitu- 
tion is to be kept in view. I refer you to what was recommend- 
ed for the preservation of health. And I will only add, that you 
should be more cautious in avoiding irregularities; take exercise 
in open air, on foot, or on horseback; have your skin well rubbed 
with a coarse brush every night; evacuate your bowels every day; 
have your decayed teeth extracted; lastly, use the salt bath eve- 
ry morning, until within a few days of the expected return. 

PERIOD OF CESSATION OF MENSES. 

This is with most women a very critical time, and deserving 
of more attention than is generally paid to it. During all changes 



161 

in the constitution, diseases are most apt to creep in; and never 
more so than at the revolution taking place in the womb at this 
period of life. As stated in the history of this evacuation, it dis- 
appears from the forty-fourth to the fiftieth year, preceded by va- 
rying irregularities in its appearance and symptoms. 

Medicine can afford no relief; yet there is no affection so per- 
fectly under the control of management. It is the dictates of 
common sense, not the effect of doses, that are to be regarded.— 
You know that this discharge for thirty years has been attended 
with considerable action and irritation in the womb, and great 
determination of blood to the part affording the secretion. — The 
important object, then, on the cessation, must be to accustom the 
system gradually to the loss of irritation, and discontinuance of 
secretion. This is to be done by exciting temporary irritations 
in other parts, and by exhausting in exercise the superfluous 
quantity of blood, and by abstinence. 

The means for the prevention and the cure of the affections 
arising at this period, are the same. There should be an unusual 
action kept up on the skin, by the roughest rubbing of it daily.— 
During half of every day, very coarse flannel, or coarse oznaburgs, 
should be worn next the skin: by wearing it longer, the skin be- 
comes so familiarized to it, that no effect is produced. A pair of 
drawers, and waistcoat for the body, is the best mode of applying 
this irritating dress. Of the utmost importance is exercise in 
open air, riding, walking, and throwing the arms around the bo- 
dy, as is sometimes done to warm the hands, or cutting a little 
wood, or any exercise like it. The diet at this time should be 
lessened for several months. Purges of salts or oils, not aloes or 
jalap, or any gum, should be taken to evacuate the system; and it 
is proper occasionally to lose a little blood, especially among the 
robust. It is of the utmost importance to keep the birth-place 
perfectly clean, as the retained secretions irritate and excite dis- 
eased action in the womb. Above all, keep the bowels daily open, 
and whenever irritation or pain is felt, try the general warm bath, 
or at least sit in a tub of warm water, and, until the pain goes off, 
remain quiet. When there appears to be considerable disease in 
the womb, to be judged by pains in it, and around the back, and 
by the sympathy of other parts with it, as pains in the stomach, 
head and breast, it is proper to apply a blister plaster between the 
U 



16S 

shoulders. In milder cases, the application of this plaster two or 
three hours, to redden the skin, without blistering it, will do 
much good. The injection of warm water up the birth-place, 
will also be of considerable service, as also injecting it up the 
bowels. If tlie inflammation of the womb be considerable, it will 
be proper to vary the injection; to substitute cold water and a so- 
lution of lead (a tea spoonfull to the pint) for the vagina. A 
large blister over the belly, to be dressed with mild sweet oil, will 
greatly assist in diverting the action from the internal parts. 

I wish to impress you strongly, that you are not to seek relief 
from opiates, so generally and improperly taken. They add to 
the disorder, by stimulating the system, already too inflammato- 
ry — sometimes when the pulse is low. The warm bath continued, 
blood-letting, keeping the body quiet and cool, afford the safest 
anodynes in these cases. 

By attending to these general directions, I can promise you re- 
lief from present pain, and from a distressing succession of future 
complaints. No lady need apprehend cancerous womb or breasts, 
who will give a reasonable compliance to what I have urged; nor, 
probably, any of the affections occurring at this revolution in the 
system. 

FLUOR ALBUS, OR WHITES. 

This is an increased secretion from the glands lining the vagi- 
na and womb; and it is an affection so local, that the constitution 
is seldom affected by it. The qualities of the discharge vary con- 
siderably. u In the mildest form, it is slimy, resembling the white 
of an eg^, having very little colour or smell. In the next degree, 
it is of a yellowish colour, but the colour not very deep, and the 
discharge not offensive. In a greater degree of disease, the co- 
lour is inclined to green, and the discharge is slightly offensive, 
and somewhat irritating. In the worst form, it resembles purulent 
matter, is ill smelled, and frequently mixed with blood. 

" The simplest and slightest kind is not attended with pain in 
the back; the general health not much affected; the strength 
scarcely diminished, though the back is rather weaker. The men- 
strual discharge is not interrupted, or irregular. In the next de- 



163 

gree, the back is constantly weak, and after any exertion aches 
considerably; the power of digestion is diminished, and the bow- 
els are generally costive; the menses continuing pretty regular . — 
Sometimes there is a feeling of heat and itching about the lips of 
the vagina. In a greater degree of this complaint, the back is 
constantly painful, and very weak, and there is a feeling of much 
weight or relaxation about the lower part of the belly and top of 
the thighs. The menstrual discharge is either obstructed, or 
rendered irregular or profuse. The stomach* is much impaired 
in its vigour, the bowels costive and flatulent; there is want of ap- 
petite, heart-burn, the face pale and unhealthy, palpitation, hyste- 
rical appearances, and the constitution seems altogether to be 
very much debilitated. This state is always productive of bar- 
renness. 

" The quantity of this discharge is as variable as the quality; 
in some cases very little, in others very profuse; in some continu- 
ing uniform, in others it increases or diminishes, or may altoge- 
ther disappear for a day or two, or for a longer period. While 
the menses continue, the discharge of this disease often increases 
before and after the monthly period: sometimes when the menses 
are obstructed, it is greatly increased, attended with additional 
pain in the back; when the discharge comes from the womb alone, 
and not from the birth-place, it is sometimes interrupted for a 
day previous to menstruation; and if the patient conceive, it im- 
mediately stops. On the other hand, the discharge from the pas- 
sage alone is often increased during pregnancy; and in some, in- 
stances, takes place only at that time. 

" This disease may arise from many causes, but particularly 
from those impairing the power of the womb itself: as a severe 
labour, or miscarriage — -particularly if the patient get up too 
soon, and mismanage herself,- or from profuse menstruation, or 
much fatigue, or exposure to cold at the menstrual time, or at 
any time, in the same way as discharges are produced from the 
glands of the nose, or wind pipe, which we observe in colds."*— 
Dr. Burns. 

The treatment of this complaint depends on its degree; in slight 
degrees of it, washing two or three times a day in cold water, is 
sufficient. It is best to inject the water into the passage to the 
womb. In all cases, great cleanliness should be observed, as the 



164? 

excretion remaining in the passage changes to an acrid, irritating* 
state, and increases the secretion. 

If the use of cold water do not suffice, it will be proper to use 
other articles that abate inflammation. The best is sugar of 
lead, about a tea spoonfull to the pint of water, injected at least 
three times a day. The same quantity of white vitriol, in equal 
solution, is also esteemed of great efficacy. Four or five times 
the quantity of alum, in the same quantity of water, may be used. 
A decoction of white oak bark, is highly recommended. If the 
discharge be very offensive, a small spoonfull of very finely pow- 
dered charcoal, maybe introduced up the birth-place every night 
and morning. Sometimes a small quantity of laudanum may be 
added to the solutions injected. Such treatment will give pre- 
sent relief. 

But it is of the greatest consequence to prevent its returns, by 
diverting the action of the blood vessels to some other part of the 
body. All the means pointed out for relieving profuse menstrua- 
tion, must be pursued; they are to be applied in the one case as 
rigorously as in the other. The only additional direction I have 
to give, is, to apply a small blister, either between the birth-place 
and fundament, (called perineum,) or a large one on the small of 
the back, or in front of the lower part of the belly; at the same 
time, more freely using the injections, to restrain the action of 
the vessels in the birth-place. I conclude; urging you to preserve 
the general health by the means pointed out before, especially by 
exciting action on the surface of your body; and take great care 
never to let any old acrid matter remain on the part, or in the bow- 
els. 

HYSTERIC FITS. 

The following description of this disease by Dr. Denman, is as 
good as can be given: In a well marked hysterical fit, a sense of 
pain or fullness is felt in the belly near the navel, or towards the 
leftside. This gradually spreads, and a sensation is felt as if a 
ball passed upwards and stuck in the throat. The patient now 
usually falls down insensible, or convulsed, and seems to suffer 
much in breathing, sobbing violently, or uttering a kind of shriek. 
She is generally pale, and frequently apparently insensible during 






a great part of the fit; or seems to be in a faint: but when she re* 
covers, she is not only conscious of having been ill, but also of 
many circumstances which occurred during the fit. After re- 
maining for a considerable time in a state of muscular agitation, 
alternating with- an appearance of fainting, the affection abates.— 
She utters deep sighs, opens her eyes, and looks around her, as 
if surprised, and at length recovers both composure and sensibil- 
ity, but remains for some time languid, and complains of head- 
ache. This restoration is accompanied with eructation, and the 
discharge of a quantity of limpid urine. The duration of the fit, 
as well as the circumstances attending it, vary much. In some 
instances, it lasts only a few minutes; in others, for more than an 
hour. Sometimes there is great muscular agitation, or pretty 
strong convulsions; at other times, the fit resembles more a faint. 
In some instances, violent fits of laughing and crying alternate 
with each other, whilst in many cases these symptoms are en- 
tirely absent. 

Most women are subject to some of the irregularities of this 
disease, as manifested by too acute sensibility. The time is 
about the period of menstruation, when their systems appear to 
have great irritability. The acrid secretion coming from the 
womb, tends to irritate the external parts, and produce the dis- 
ease: and it is also probable that it is frequently attended with 
some particular state of the womb itself. 

They are most subject to it who lead a sedentary life, breathe 
foul air, and retain their excrement too long in the bowels. The 
acrid contents of the lower guts readily excite action in the ad- 
joining womb, and produce disease. Next, the adherence of the 
ordinary secretion of the glands about the birth-place, which, irri- 
tating the sensible parts, cannot fail to produce similar effects. 
Lastly, irregularities in eating and drinking. The disease, once 
excited, is very apt to become periodical and appear without any 
exciting cause. 

The prevention consists in guarding against the causes men- 
tioned with the most earnest diligence. To sleep with the bed- 
room door open, and to take moderate exercise out of doors daily, 
is indispensably necessary; or by all means, they should sit daily 
in a tub of cold water. The excitement of any sudden or strong 
passions should be carefully avoided, as also indulging any length 



166 

of time in particular habits or whims. Travelling and salt bath- 
ing, are of great service. When it is necessary to open the bow- 
els with medicine, it should be done with aloes, in preference to 
all other purges. Glysters are extremely advantageous. About 
the time the fit is expected, it is best always to take about five or 
six grains of aloes, as well as a glyster. Purging is very proper, 
as the contents of the bowels are always offensive in this disease. 
A desert Spoonfull of prepared chalk, or as much charcoal in 
yeast, will tend to correct this offensiveness. The system of the 
person should be as much revolutionized, or changed, in order to 
destroy the habit of such returns of action, as possible. Bleeding 
in addition to the purging, is often requisite. An emetic may be 
given, with great advantage, before the expected time. The 
skin should be irritated by the roughest friction; the mind should 
be kept as mildly occupied as possible. This disease is most as- 
suredly under the control of such treatment, earnestly attended 
to; and its recurrence among those aware of the prevention, af- 
fords grounds for reflection on their inattention and indolence. 

The treatment when the fit comes on is very simple: Let the 
patient be placed in cool air, on the bed or floor, and turn and 
writhe, so long as they do not hurt themselves. This is to be 
prevented by holding them. Volatile salts, or any thing pungent 
or offensive to smell, should be held to the nose. It is said, a 
Yankee Doctor, not having any thing at hand, once successfully 
applied his toes to the nose of his hysteric patient. The limbs 
should be rubbed with a stiff brush. The moment it can be done, 
pour down the throat, either twenty grains of ipecacuanha, or a 
solution of three grains of tartar emetic, or a table spoonfull of 
antimonial wine. As soon as the vomiting commences, the fit 
generally ceases. After the operation of the vomit, you should 
give of aloes and asafoetida, of each four grains; this is to be re- 
peated on any symptoms of the return of the disorder. If none 
be at hand, give thirty or forty drops of laudanum and any pur- 
gative. If laudanum be not at hand, use a glass of brandy toddy 
or wine, with hard rubbing in warm water. 

It has been supposed that this disease arises from a peculiar 
state of the womb. Our means of operating on the womb are but 
few: we have none more powerful than through the breasts. I 
would therefore press on those subject to periodical returns of 



167 

hysteria, which do not yield to the treatment before suggested, to 
excite the breasts to their healthy action, the secretion of milk, 
so as to influence the womb. The means of doing this will be 
stated on the subject of barrenness, to which I refer. 

HISTORY OF PREGNANCY. 

At the sexual intercourse between man and woman, when the 
circumstances have been favourable for conception, the seed of 
the male is supposed to enter the womb of the female, and uniting 
with the seed of the woman, comes down through the tubes call- 
ed the fallopian, and forms the commencement of our bodies. — 
At the same time is formed what is necessary for the growth; 
that is, a coat or covering to include the whole, and lining the 
womb, called the membranes; also, a fleshy substance, almost like 
the liver, called after-birth, or placenta. This after-birth receives 
and prepares the blood supplied by the womb for the child; — 
there is a tube passing from the after-birth to the navel of the 
child, called the umbilical or navel cord; the tube is for the pur- 
pose of the circulation of blood between the mother and child;— 
lastly, is also formed a liquid, called among women, the waters, 
resembling in its nature the white of eggs, a fluid in which the 
child moves. Thus the contents of a pregnant womb, formed in 
miniature at conception, are the child, the waters, the membranes 
holding them, the navel cord, and the after-birth. The natural 
history of their growth is thus stated by Count Buffon: " Imme- 
diately after the mixture of the seminal fluids, it is probable the 
whole materials of generation exist in the womb, under the form 
of a small globe. This globe is formed by a delicate membrane, 
which contains a limpid liquor, very like the white of an egg. In 
this fluid may be seen some small fibres, which are the first rudi- 
ments of the young. Upon the surface of this globe there is a 
net work of delicate fibres, which extend from one end to the 
middle, forming the beginning of what is termed the placenta, 
after-birth, or secundines, which is the part connecting the child 
to the mother. 

Seven days after conception, parts of the child are distinguish- 
able to the naked eye, very imperfect; appearing as of a clear 



168 

jelly, though of some degree of solidity. The head and trunk 
may be easily distinguished, it being of an oblong figure, the 
trunk being longest and most delicate. Some small fibres, re- 
sembling a plume of feathers, issue from the middle of the child, 
(the navel,) and terminate in the membrane by which the whole 
is enclosed. These fibres are the rudiments of the tube connect- 
ing the young to the after-birth, called the umbilical cord, or na- 
vel string, which connects to the after-birth, or placenta. 

Fifteen days after conception, the head and most prominent 
features of the face are apparent. The nose resembles a small 
elevated thread, direct over a line which marks the division of 
the lips; two black points represent the eyes; and we see two 
holes in place of ears. The body has also acquired some growth: 
on each side projections appear, which are the rudiments of the 
arms and legs. In three weeks, the body is a little enlarged; both 
the arms and legs are visible. The growth of the arms is quick- 
er than that of the legs; and the fingers separate sooner than the 
toes. The internal parts now appear; the bones seem as threads. 
The ribs are disposed on each side as fine threads; the arms, the 
legs, the fingers, and toes, are also represented by similar threads. 

At one month, the young, called the foetus, is an inch in length. 
It takes a curved posture in the middle of the liquor that sur- 
rounds it; and the covering or membranes, in which the whole is 
included, are increased and thickened. The whole mass is about 
an inch and a half in length, of an oval or egg shape. All the' 
parts of the face may be seen; the body is visible; the haunches 
and belly are prominent; the hands and legs are formed; the fin- 
gers and toes are divided; the skin is thin and transparent; the 
parts in the belly resemble a knot of fibres; the vessels are as fine 
threads; the bones are still soft, only a few places beginning to as- 
sume some degree of solidity. The vessels forming the navel 
cord extend in a straight line. The after-birth now occupies less 
space than in the beginning, though its solidity has increased, 
and it has become thicker than the covering or membranes co- 
vering the whole. 

At the end of six weeks, the foetus is about two inches long; 
the form is more perfect, only the head is longer in proportion to 
the other parts of the body. About this time, the motion of the 
heart is visible: in fifty days it was perceived to beat for a con- 



169 

siderable time after the foetus was extracted from the womb. In 
two months, it is more than two inches in length; the formation 
of the bones being much more visible. In three months, it is 
near three inches in length, and weighs about three ounces.— 
Some women affirm they have felt its motions about this time; 
but it is difficult to be certain: motions in the neighbourhood are 
mistaken for those of the child. Yet the sensations excited by 
its first motions, depend more on the sensibility of the mother, 
than on the strength of the child. Before the end of the third 
month, the head is bent forward, the chin rests on the breast, the 
knees are elevated, and the legs folded back upon the thighs. — 
One of the hands, often both, touch the face. Afterwards, as it 
acquires more strength, it perpetually changes its position; though, 
in general, the head inclines downwards." 

It is at the fourth month, that generally the mother feels the 
motion of the child within, which is called quickening; and which 
in some produces very considerable alarm; sometimes sickness, 
hysterical symptoms, vomiting in the night and in the day, either 
repeated or not, for days. This motion is the only infallible 
symptom of pregnancy; and generally terminates the unpleasant 
sickness and diseases preceding. 

After this, the development or growth of the child becomes 
much more rapid than in the beginning. At first the waters, 
membranes, and after-birth, were much larger in proportion to 
its size, than at this time, and every day this difference is in- 
creased till the birth, when, in bulk, they appear very inconsider- 
able in comparison with the child. 

About the time of quickening, the womb may be felt floating, 
as it were, in the lower part of the belly; particularly if the wo- 
man relax the surrounding parts by not exerting them. Before 
this, while the womb is retained in the pelvis, upon putting a 
finger up the birth-place, while the woman is standing, the mouth 
of the womb may be felt, lower than in a natural state, as its ad- 
ditional weight causes it to descend. This is very perceptible 
for some weeks after conception. After this it enlarges, and ap- 
pears ascending up in the belly, till it grows so large as to be un- 
able to descend through the pelvis. 

After conception, the breasts become rather smaller; but in the 
third month, they enlarge; the nipple is surrounded with a brown 
V 



170 

circle, and frequently a milky fluid can be pressed out. The bel- 
ly at first becomes somewhat flat, but very soon increases in size 
in the lower part. In the fifth month, the womb begins to ren- 
der the belly hard, and may be felt as a ball rising to the middle 
point between the pubes and navel. In the seventh month, it 
reaches to the navel; in the eighth, half between that and the 
breast bone; in the ninth, it nearly touches that bone, particular- 
ly in first pregnancies, when the resistance of the belly prevents 
the hanging down, as in following pregnancies. 

With some persons, generally in the best cases, after the expi- 
ration of nine calendar months, or forty-two weeks after menstru- 
ation ceased, the child is so well made, that it is able to live with- 
out connection with the mother, making allowances for a few" 
days variation: and the delivery, effected by the contraction of the 
fibres of the womb, which are not designed longer to bear the ir- 
ritation of such distension, takes place. Sometimes not till the 
hour of delivery, sometimes a few days, at others two or three 
weeks, the woman feels an increase of anxiety, busies herself for 
the reception of the infant, moves with difficulty, and frequently 
complains of restlessness, and pains in the back and loins. As 
the period approaches, Tier belly subsides most, in the most fa- 
vourable cases; her discharge of urine is affected, sometimes 
suppressed, at others not to be retained; occasionally a lax, ge- 
nerally she is rather costive; and she perceives a discharge of 
mucus from the vagina, tinged with blood. But the history of 
this expulsion will be presently given. 

As was remarked, the liquid called " the waters," in a healthy 
state, resembles the whites of eggs. Among many, however, 
this appearance does not exist, and the waters become of various 
qualities; sometimes extremely offensive. The quantity of the 
waters is also subject to great variations at birth; in some cases, 
there is scarcely half a pint, in others half a gallon has been 
found. 

The means nature provides for the growth of the child are ve- 
ry remarkable. As stated in the- commencement, the growth is 
entirely effected through the after-birth or placenta, which pre- 
pares the blood in the proper condition, as our lungs do for respi- 
ration; and then it is transmitted by the umbilical or navel cord 
to the child. The after-birth is a fleshy substance, its edges thin, 



171 

differing in weight from one to two pounds; it adheres to the 
Sides of the womb, often to its upper part, called fundus, and re- 
ceives the blood from the womb. 

The navel, or umbilical cord, is composed of two veins, which 
come from the after-birth, and an artery coming from the child, 
twisted round so well, as to resemble one cord. The blood Car- 
ried through the ve-ns, enters at the navel of the child; thence, in 
proper vessels, is conveyed to the heart, and by it diffused over all 
the body for its growth. It returns from thence, and, by the pow- 
er of the heart, is sent back through the artery of the cord to the 
placenta, or after-birth, where it again undergoes the change ne- 
cessary for fitting it for the use of the child. The length of the 
cord through which it passes varies considerably. It has been 
known not to exceed six inches, and in other cases to be thirty 
inches. About eighteen inches is its ordinary length, 

Some women, on conceiving, feel such an alteration in the state 
of the stomach, or in their sensations in general, as apprizes them 
of their situation, "But, usually, the earliest notice is afforded 
by the obstruction of the monthly discharge. This is an invaria- 
ble effect of conception; but it must be recollected, that it may 
take place from other causes. Early after conception, the sto» 
mach is affected, heart-burn, sourness on the stomach, want of 
appetite, disgust at the usual food, and sometimes a craving for 
things formerly not desired. Frequently the woman is sick in 
the morning, vomiting after getting up, though some are only 
sick in the afternoon, sometimes troubled through the day with 
qualms, faintiness, and inclination to vomit. Some have a con- 
stant desire to spit, have the tooth-ache, cough, and other affec- 
tions of variety of kind and duration, differing in every case. 

In some cases, the complexion greatly suffers in pregnancy, 
the features being affected, as in cases of children with worms; 
in other cases, the looks are much improved. Sometimes the 
pulse is as common, though generally it is quicker. Perhaps 
there is no woman who does not undergo such an alteration in 
parts or the whole of her system, after conception, as would ena- 
ble an attentive observer to ascertain the fact. But it is enough 
for you to know, that there is no one certain sign of pregnancy, 
excepting the visible motions of the child. In all those cases 
where doubt exists, and the object is to ascertain the fact, for 



172 

purposes of punishment, both men and women should unhesitat- 
ingly decide on the safe side, suspending all judgment, till proof 
be unquestionable. 

CAUTIONS DURING PREGNANCY. 

In order for you to discover the very best modes of conducting 
yourselves during pregnancy, you have only to make a few com- 
mon observations, and exert a little common sense. The course 
pointed out by nature, pursued by all the pregnant animals, from 
inclination; by the women in the lower classes of society, and in 
the savage state, from necessity, is the course you must discover, 
is the proper one for you to pursue, in order to ensure successful 
child-bearing. It is known that all our domestic animals: mares, 
cows, sheep, and the like, produce the best young in the largest 
pastures; and that women moving about in the country have 
much finer children than those leading sedentary lives in town. 
Is it necessary that I should press on you the truth, that moderate 
exercise in open air, not by starts, but long continued, with sim- 
ple diet, regularly taken, so necessary for the health of your bo- 
dies at all times, is more especially so, during the critical period 
of child-bearing? It is to be regretted that so many pregnant 
women lead such inactive lives, not only on their own account, 
but on account of their children; for doubtless, it is owing to the 
sluggishness of the actions of the mothers that so many in socie- 
ty are mere masses of flesh and blood. Among the Indians, such 
want of genius could not be found. Pray believe the declaration, 
that it is necessary to take the trouble, to make efforts to secure 
what we want. If you desire health, you must take the trouble 
to walk or to ride about every day; to breathe a fresh, pure air by 
night and day, as well for your own as your infant's sake. You 
must confine yourself to a plain, simple diet, abstaining from eve- 
ry thing stimulating; keep your bowels regularly open, and sit 
daily in cold water. Your sleep should be regulated with great 
attention; night companies abandoned, and all exposures, particu- 
larly to such as may suddenly alarm you. Your dress should be 
loose, without tight bandages binding any part of you. I will 
not speak of your lacing yourselves, confining your waists, com- 
pressing your breasts and the contents of the womb; because the 



178 

laws are defective in their operation, for not giving prompt 
punishment to the mother, who, from feelings of vanity, becomes 
accessary to deforming and destroying the unfortunate contents 
of her womb. 

I again give you the caution of voiding your urine frequently, 
and particularly, on having the least desire; which was pressed 
while treating of the womb. You should refer to it, and remem- 
ber that the mischiefs of inattention may be incalculable. 

As of next importance to the evacuation of the bladder, is the 
daily evacuation of the bowels. What I have urged on this sub- 
ject before, I would press with increased zeal on pregnant women. 
It is of ten times the importance during pregnancy. The womb 
pressing on the lower gut, lessens the ability to evacuate; but per- 
severe, and do not remit, till daily at the same hour your bowels 
are opened. Some have neglected this to such a degree, that 
they have had a confined column of excrement in their bowels of 
great length, requiring that they should have it scooped out with 
the handle of a spoon. If you cannot have a natural evacuation 
daily, from your own efforts, take an injection; there will be in 
the end a real saving of trouble by the operation. 

The system of women during pregnancy, is always more or less 
inflammatory; even among the emaciated. Their bodies convert 
the fat of every part into the circulating blood; which, when 
drawn, has the buffy coat, characteristic of the high action of 
their bodies. There is generally increased irritability of temper, 
marked by great fretfulness; requiring soothing, not provoking 
returns. Those who are well should commisserate them; and 
those pregnant should labour to restrain their petulance and vio- 
lent temper; constantly bearing in mind, that their acuteness of 
feeling arises not from the hard circumstances in which they 
live, but rather from a morbid action in their bodies. 

This irritability of the system and mind may be lessened, by a 
moderate use of the mild tepid bath. The hot bath has produced 
abortion; but sitting in a long vessel of milk-warm water, cover- 
ing thighs and legs, having it gently poured around the belly, the 
skin slightly rubbed with a soft hand, will have a strong tendency 
to preserve and equalize the healthy action of the womb and ad- 
jacent parts. 



174 

DISEASES DURING PREGNANCY. 

Some women complain greatly of pain in the ptebes or front 
bones, particularly in advanced pregnancies. The womb hangs 
over the pubes, presses on them, and produces this uneasy feel- 
ing. This complaint may be lessened by the above bath; but 
most by wearing a bandage around the shoulders, extending down 
each side and around the under part of the belly, so as to support 
it. This at the same time prevents the belly from hanging over, 
and becoming so pendulous after delivery. The application of 
the bandage should be when the person is lying down; it should 
be very wide, several inches where the belly rests on it; and drawn 
so as merely to be felt in that position. When the woman rises, 
the abdomen will rest on it, and great support will be derived 
from it throughout the day. 

Some women have the lower bowels inflamed by the pressure 
of the womb, and also a constant desire to void the excrement.-— 
The relief for this is moderate blood-letting, sitting in a tub of 
warm water, and a slight purge of salts or oil; rest, and laying 
on the belly will be of service. Sometimes the piles are particu- 
larly distressing in pregnancy, to be relieved by the means which 
will be pointed out, when treating of their cure. 

SICKNESS OF STOMACH. 

The next complaint I shall mention, is sickness of stomach and 
vomiting. Generally this does no harm; but when excessive, it 
is to be relieved by moderate bleeding, by keeping the bowels 
open, by cupping, or applying leeches to the stomach, and rub- 
bing laudanum over it; also, with the application of hot cloths to 
it. The saline draught, made of lime juice and salt of tartar in 
effervescence, is very good. Soda water has been drank with suc- 
cess; lemonade, and the like common articles. The internal use 
of laudanum should be avoided; though sometimes stomachic ov 
cordial medicines become requisite. 



175 



HEART BURN. 

For heart-burn, the general prescription is prepared chalk, a 
Lea spoonfull mixed in water or milk at a dose, every two or three 
hours. A little soda, potash, or magnesia, may occasionally be 
taken; sometimes gum arabic and liquorice have done service. — 
The best remedy is a few drops of spirit of hartshorn. I have 
known large quantities of warm water, quickly drank, to relieve 
the symptoms; gentle vomiting, in distressing cases, might be 
tried, excited by putting the finger down the throat. A little 
bleeding has sometimes done good; and regular exercise seldom 
fails to produce the like effect. 

COLIC. 

In cases of colic, or pains in the bowels from flatulence, when 
violent, blood-letting should be resorted to, if not at once relieved 
by injections of warm water; a moderate purge of oil, salts, man- 
na, or cream of tartar, should always be taken. The bowels, du- 
ring colic, should constantly be kept open, by keeping a piece of 
soap in the fundament. Sitting in a tub of warm water, or ap- 
plying hot cloths wrung out of hot water, will alleviate the pain. 
A. little peppermint sometimes affords relief. 

SWELLED LEGS. 

Swelled legs are very common in the pregnant state. Towardsr 
the last, they are often a source of pain and great uneasiness.-— 
They are produced by the pressure of the distended womb on the 
vessels returning the fluids from the lower extremities. General- 
ly they disappear at night, and return daily, particularly in the 
evening. Fortunately they are not dangerous. A recumbent 
posture lessens the swelling considerably. Moderate bleedings 
occasionally are requisite. No local remedies afford half as much 
relief as wearing laced stockings; sometimes the common stock- 
ings, lengthened so as to reach to the body, and fitting very tight, 
answer sufficiently; these resist the distension, and support the 
parts; delivery always terminates this disease-. 



176 

During pregnancy, women are always subject to the same com- 
plaints as in the unimpregnated state. For their treatment, pro- 
fessional characters should always be consulted. They should 
bear in mind that their systems in this situation are very inflam- 
matory; and that the remedies ought not to be so strong as in 
other states, particularly when applied to the bowels. Powerful 
purgatives should never be taken; and all that shocks the system 
should be carefully avoided. 

« CRAMP. 

Doctor W. Moss, a most excellent and judicious writer, of Li- 
verpool, states, on this subject, that " the cramp is not an uncom- 
mon attendant on pregnancy, and will attack those at this time, 
who seldom or never have it at any other. It seldom comes on 
before the fourth month, and is most common at the latter parts. 
It most frequently attacks in the night, in bed, in the legs, some- 
times in the thighs, hips, and belly. 

"Getting up, and standing barefoot on the cold hearth, is a 
common remedy, and, so far as I have observed, is a safe one.— 
In cases of costiveness, keeping the body open will frequently mi- 
tigate it; as also bleeding, when it is severe and frequent. It will 
oftentimes be rendered more severe by unusual exercise or fa- 
tigue. If instead of the usual way of rubbing the cramped part 
with the hand, the part is strongly pressed or grasped with the 
fingers and hands, more present and temporary relief will be 
had." 

Pouring cold water on the part, rubbing with a woollen cloth 
briskly, and sleeping under fewer bed clothes, will be found of 
service. 

FLOODING. 

The most important and fatal of all complaints to which preg- 
nant women are exposed, is what is called flooding, or loss of 
blood from the womb. This is brought on by alarms, falls, jolt- 
ing, over-action, and sometimes from no visible cause. The 
membranes lining the womb, particularly the after-birth, sepa- 
rate from their adhesion to the womb, and the large blood-ves- 



177 

sels entering into it, discharge the blood, which then passes 
through the mouth of the womb in large quantities. The com- 
plaint is the more alarming, as the danger is of the most immi- 
nent kind when least apparent. Death frequently ensues with ve- 
ry inconsiderable warning. 

The treatment of flooding requires much attention and skill.-— 
In all cases, medical aid should be had the moment the disease 
appears. If it cannot be had, you must make the patient contin- 
ue in bed, as cool, and with as much fresh air, as will be tolera- 
bly comfortable. In the beginning, she should always be blooded 
freely, rapidly, so as to produce fainting, which should never be 
checked, as it is at this moment that those clots of blood are 
formed, which put a stop to the flooding. If no one can be had 
to bleed directly, bandages around the arms and thighs, so as not 
to hinder the pulsation, may be applied until the arrival of a bleed- 
er. Cool air being admitted, the bowels should be opened with 
a clyster of cold water: every thing heating, as warm clothing, 
stimulating drinks and diet, should be avoided. If the blood con- 
tinue to flow considerably, stuff* up the birth-place a cloth to stop 
the passage. A cold wet cloth on the belly will tend to stop the 
discharge: this should be renewed every two or three hours; — a 
bag of ice is the best application. These cold applications (sit- 
ting in cold water has been found good) should not be continued 
so long as to produce chills. If the bleeding still continue, two 
grains of sugar of lead should be given every hour, until it ceas- 
es, or until five or six doses are taken; about twenty grains in a 
quart of water, one-fourth injected in the bowels, and the remain- 
der used in washing the birth-place,, will expedite the cure: it 
may be repeated two or three times. Almost always these reme- 
dies relieve the discharge for the present. The great danger is 
in its return. In order to prevent the return, no matter how well 
the patient feels, she must continue in bed two or three weeks, 
cool and quiet, and ready at all times to apply the cold, wet rags 
up the birth-place, in case of return. I warn you not to disregard 
this cautious conduct; if you do, ten chances to one, you are dead 
without an hour's warning. 

When the flooding returns, in great degree, in spite of all ef- 
forts to prevent, the woman becoming extremely pallid, showing-, 
excessive loss of blood, but one remedy is left, and that is to pro- 
W 



178 

duce an immediate abortion. Unless the danger be very press- 
ing, the advice or direction of a physician should be taken before 
the destruction of the child. It should, however, be always re- 
membered, that the life of the child is not to be compared with 
that of the mother. A forced delivery being determined on, a 
woman with small hands should be the operator. 

The patient should lay on her side, her thighs drawn up near 
her belly, with a pillow between them. The woman operating 
should grease her right hand well with the mildest lard or oil, 
and folding her fingers together as round as possible, should very 
gradually introduce or push them up the birth-place, gently dilat- 
ing or extending the parts as she carries her hand forwards.— 
When her hand arrives at the mouth of the womb, she will per- 
ceive its edges or lips, and between these she must gently insinu- 
ate her finger, so as to pass through the membranes holding the 
waters: this being done, the waters immediately flow out, and the 
womb begins to contract. If the flooding cease in this stage, it 
is well to stop; but if the womb appear relaxed, not contracting, 
it is necessary to go on, gradually insinuating the fingers in the 
mouth of the womb, then opening them gently so as to enlarge 
it; then still gradually introducing the hand and arm, and passing 
the head of the child, feel for a foot, which you will distinguish 
by the heel, the toes, and the difference in its feel from the hand, 
if you hold it as if to shake hands. After taking hold of the foot, 
it is to be brought down to the birth-place. But the following 
from Dr. Bard, is a better description ol the operation than I can 
give: " Introducing the hand into the womb, turning the child, 
and delivering by the feet, is an operation seldom attended with 
much difficulty or danger, provided it be performed early, before 
the waters of the womb are fully discharged, and with due delibe- 
ration and caution. Whenever it is determined on, let the woman 
be brought down to the edge of the bed, still lying on her side, 
or, as I have generally found most convenient, on her back; her 
hips a little raised, and her feet supported on the lap of an assist- 
ant on each side; whilst a double sheet spread under her, over the 
laps of the assistants, and that of the accoucheur, (sitting on a 
low seat before her,) protects her from cold, and another thrown 
over her, forms a decent covering. The hand then lubricated 
with good oil, or fresh hog's lard, and the fingers collected into a 



179 

cone, is to be gently and slowly introduced, through the vagina 
to the womb; which, in some women a little advanced in life, es- 
pecially in case of a first child, may make so much resistance as 
to require an hour or more, employed in gradual and cautious 
efforts to overcome, when the circumstances of the case will ad- 
mit of such delay. The internal orifice is next to be dilated, by 
introducing first one finger and then another, until by slow and 
gentle attempts it will admit the hand; remembering always, 
that by the natural contractions of the womb, the orifice will be 
more safely and easily dilated, than by the finger. Whenever, 
therefore, the pains occur, our efforts to dilate are to be suspend- 
ed, and the pains are to be permitted to produce their effect on 
the hand. When the pain ceases, a gentle distension is again to 
be made, which will probably soon occasion another pain; which 
is again to be permitted to produce its effect. And on some occa- 
sions, just as the hand is passing into the womb, it is to be opened 
and laid flat, lest a violent contraction on the knuckles should in- 
jure, perhaps rupture the neck, which is the part most liable to 
such an accident. The orifice of the womb being sufficiently di- 
lated, if the hand can then be easily passed over that part of the 
placenta which has been already separated, until it reach the 
membranes, that is to be done; and, breaking the membranes, it 
is to be immediately passed into the womb. But if we cannot 
readily pass the separated portion of the placenta, and the flood- 
ing be profuse, it may be necessary to pass through the placenta; 
which is less dangerous either to the mother or child, than to se- 
parate a larger portion, by passing the hand between it and the 
uterus. The hand being introduced into the womb, the neck 
will generally cling so close round the wrist as to prevent the es- 
cape of much water, and we shall find room to act with freedom; 
and as the same pressure generally suspends the haemorrhage, 
we may take time for deliberation. It is therefore generally pro- 
per at this period to rest a few minutes, to recover any fatigue 
we may have sustained; and to refresh the woman by some pro- 
per drink, whilst we deliberate on the circumstances of the case, 
consider the position of the child, and the readiest way to get at 
the feet. It will be recollected, that the most natural presenta- 
tion is the most common; and that in that case, the child's head 
is at the brim of the pelvis, with the face and belly to the back 



180 

of the mother, the knees bent to its breast, and the feet towards* 
the upper part of the womb. As, therefore, the child must ulti- 
mately be turned, this may be the best time to push the head and 
shoulders up towards the fundus, and to turn the face of the 
child to the back of the mother; which is most easily done with- 
in the membranes, and by which the feet will be brought within 
reach of the hand; and having secured them, they may be easily 
brought by a waving motion into the vagina. It is always best, 
when it can easily be done, to bring down both feet; one, howe- 
ver, will answer, and generally the child can be turned and deli- 
vered by one, with nearly as much ease as by both. In bringing 
down the feet, bend them a little to either side where you find 
most room, and remember always to desist during the action of 
a pain, and proceed again during the interval. After this, we 
may take the assistance of the pains in delivering the hips and 
body of the child; cautiously extracting during the pains from 
side to side, and from pubes to sacrum. As the hips are brought 
down, carefully consider again how the child lies in the womb; 
with its belly to the belly or back of the mother; and take care, 
if it shall be necessary, to turn it gradually, so that by the time it 
shall be delivered as far as the arm pits, the belly of the child 
shall certainly be to the back of the mother, which is the posi- 
tion in which the arms and head can be most easily delivered. — 
And now, or rather somewhat before this, examine the navel 
string, and occasionally pull it down a little, so as to prevent its 
being put on the stretch. If the pulse in the navel string be strong, 
and the flooding suspended, we may still proceed with delibera- 
tion, and take the assistance of the pains in accomplishing the 
delivery. But if the pulsation has ceased in the cord, or if the 
woman floods freely, either the child or the mother may be lost 
by delay; and it becomes necessary to finish the delivery as soon 
as we prudently can. If, therefore, the child's arms make any 
resistance, introduce one finger under the pubes, and carrying it 
along the child's arm to the elbow, pull that down a little, then 
go on to the wrist; it will easily turn down into the hollow of the 
sacrum, and be delivered: the other arm will be still more easily 
delivered in the same way. But let it always be remembered, that 
caution and dexterity are more necessary than force; by which, 
unskilfully applied, there will be great danger of breaking the 



181 

child's arms. Having delivered the arms, lay the body of the 
child on your left arm, and passing two fingers of that hand into 
the vagina, introduce them into the child's mouth, and draw the 
lower jaw down a little, so that, if possible, you may extend the 
fingers above the mouth along the child's nose; then placing the 
fingers of the right hand across the child's neck, again cautious- 
ly extract during the pains, sometimes pulling down towards the 
sacrum, again up towards the pubes, and from side to side; and 
again pushing down and backwards towards the hollow of the 
sacrum, so as to free the occiput from the pubes. The chin be- 
ing brought down, stand up, and raising the back of the child to- 
wards the belly of the mother, the face will turn out from the pe- 
rineum, and the delivery be finished. 

In giving this description, I have purposely supposed the most 
favourable circumstances that occur in a case of so much impor- 
tance: the haemorrhage to be restrained by the introduction of the 
hand, and the greater part of the waters to be retained by the 
wrist plugging up the orifice of the womb; that I might describe 
the successive steps of the operation minutely and distinctly: but 
we must not flatter ourselves, that this will generally, or even fre- 
quently, be the case. There are few situations of greater terror 
or alarm, than a woman flooding at the latter end of pregnancy; 
and we are frequently called on to decide instantly, and to act 
promptly; yet we must never suffer ourselves to be confused or 
hurried: for, even during the operation, many occurrences may 
happen, which call as much for cool reflection, as for prompt and 
ready execution. Of these I shall take notice in describing those 
preternatural cases in which they are most likely to occur. In 
many of these cases, women are so much exhausted by loss of 
blood, that, even after a safe delivery, they require great attention 
to recruit their strength and save their lives. Rest, promoted by- 
small anodynes, in some cordial julap, such as spirituous cinna- 
mon water, or what can always be had, good toddy with nutmeg, 
are the remedies first called for: these must be succeeded by small 
portions of nourishing diet, frequently repeated, and by tonics, in 
which an infusion of the Peruvian bark and cinnamon in claret, 
agreeably sweetened, makes a pleasant and efficacious mixture. 

However, of late there has been discovered an article called 
ergot, which is the musty, dark looking heads of rye, found in 



183 

most fields of rye when nearly ripe. These heads, reduced to> 
powder, are used, it is said, on good authority, for producing- 
abortion, without injuring the mother. The dose is twenty grains 
mixed in a little molasses and water; and it is stated, that the 
operation is such, that immediately after being taken, the con- 
traction of the womb commences. Whether this medicine will 
supersede the manner of producing the delivery above pointed 
out, remains to be determined by experience. Even if it suc- 
ceeds, agreeably to expectation, I would prefer the mode of sup- 
pressing the flooding by perforating the membranes with the fin- 
ger, since without introducing the hand into the womb to turn 
the child, as above described, this perforation or bursting of the 
bag of waters has been successful; more perfectly so than I sup- 
posed, on writing the first part of the operation for turning. I 
would therefore always recommend for flooding in excess, the 
perforation of the membranes with the finger, before attempting 
to turn the child, but at the same time giving a dose of ergot. 

ABORTION. 

Connected with floodings during pregnancy, is abortion, or pre- 
mature discharge of the contents of the womb, ending in its de- 
struction. Not having had any particular experience on this sub- 
ject, I give the best brief view of it from Dr. Bard; a few words 
of which are changed. 

Abortion happens frequently, and deprives women of their 
health and happiness. Very strong and very weak women are 
most prone to it; but the numbers of the strong bear no propor- 
tion to those who are of delicate constitutions; the numbers of 
active country women, to the more indolent and inactive inhabit- 
ants of cities; the number of women of good sense, of calm and 
steady minds, to the weak, irritable and passionate: hence a most 
important lesson may be learnt, that good health and a good edu- 
cation are the best preventives. It then, in a great degree, de- 
pends upon mothers, upon the care they take in rearing their 
girls, restraining the indulgence in all passions, to lessen this 
great and common evil. 

Another observation is, that women who have once miscarried,, 
are apt to miscarry again at the same period, from the samecau- 



183 

ses, and with the same symptoms. So that if the habit be once 
acquired, it becomes difficult to remove. Hence the importance 
of great care in young women, not to miscarry in their first preg- 
nancy: and the propriety of particularly guarding against the cau- 
ses that produced it at first, in all following pregnancies. 

Miscarriages are most apt to occur between the eighth and the 
twelfth week, and from the fifth to the seventh month, periods 
which will require particular attention; though a prudent care is 
at all times necessary, as the cause of the miscarriage may, and 
commonly does exist at a much earlier period than that at which 
the abortion occurs. 

The causes of abortion may be reduced to the death of the 
child; to the separation from the womb of the bag or membranes 
enclosing it; and to the disordered contraction or action of the 
womb. 

That the child may die, independently of any disease in the 
mother, has been proved by many cases in which a healthy mo- 
ther has discharged it, with marks of considerable disease. 

A frequent causae of abortion is the separation of the membranes 
lining the womb, and surrounding the child. The extreme deli- 
cacy and tender structure of the vessels connecting this membrane 
to the womb, especially in the early months of pregnancy, renders 
the separation not very difficult, by slight causes: hence miscar- 
riages happen most frequently between the eighth and sixteenth 
week. Yet the cause operates much earlier; for sometimes, be- 
fore a small rupture occurs between the after-birth, or any part of 
the membranes and the womb, the blood is gradually effused; 
thereby increasing the separation, till the womb, being excited to 
action, expels its contents. This cause of miscarriage cannot be 
detected before labour, and is proved only by the expulsion of a 
quantity of coagulated blood, immediately before or after the de- 
livery. The causes of the separation of the membranes from the 
womb, are, generally, too much fulness of blood in the system, 
arising from free living and little exertion, indulgence in exces- 
sive joy, sudden or violent exercise, awkward postures, stimulat- 
ing food or drink, costive habit, and excessive passions. These 
operating most directly after marriage, require that greater atten- 
tion should then be paid by women to guard against them. The 



184 

remedy for this state, is moderate bleeding, keeping the bowels 
open, and temperance and regularity in every action. 

The disordered action of the womb itself, is a great cause of 
abortions. Disorders or affections of any part in the neighbour- 
hood are apt to produce it. This points out the propriety of 
promptly treating any affections about the pelvis in the most judi- 
cious and mild manner. The warm bath and bleeding are the 
great remedies, and should be administered by the ablest physi- 
cians, for all the complaints of these regions, in pregnancy. — 
From the recurrences of abortions, the womb is very apt to get 
in such a state, that it will not enlarge beyond a certain size; and 
as soon as it arrives at that size, it contracts, and expels its con- 
tents, as if from habit. This affords a powerful reason for doing 
all that can be done to prevent the formation of the habit, by pre- 
venting the first abortions. 

The signs of approaching miscarriage, are absence of the morn- 
ing sickness, subsidence of the breasts, a discharge of blood or 
of water from the birth-place, and regular labour pains. A cold- 
ness of the belly, or sense of weight, and cessation of motion after 
quickening, are said to denote the death of the child; but this is 
very equivocal, as many women have produced healthy children, 
when, from these symptoms, they were supposed dead for some 
time. In no case should the woman act carelessly, as she may 
be mistaken, and as the delivery will be always easier and safer 
when left to nature, than when hurried. 

A discharge of blood from the womb, although a very frequent 
and generally the most important symptom, is not always follow- 
ed by miscarriage; as you will find, by reference to what was said 
on floodings. 

Doctor Burns observes, when abortion is going to t?tke place, 
the patient feels pain in the back and lower part of the belly, with 
uneasiness like colic, and a sensation of slackness. This state, if 
not preceded, is soon followed by a discharge of blood, and pre- 
sently regular bearing down pains are excited. The discharge is 
sometimes from the commencement red and profuse; but in other 
cases, it is at first rather watery, or sparing in quantity; presently 
it flows more copiously, and considerable clots come away, often 
pieces of skinny or fleshy looking substance may be discovered. 



185 

In some cases, there is much pain and Uttle discharge; or the re- 
verse may happen, or both may be considerable and protracted. 
If the miscarriage takes place at a very early period, little can be 
detected except clotted blood; but if every thing be put in a basin 
of water, sometimes a more solid substance may be observed, like 
a chesnut, which, when examined, is found to contain a small bag 
of water with a child in it, no larger than a bee. If the third 
month be completed, we find that the whole conception comes 
away at once, like a bag covered with fringed vessels; or, if the 
bag burst before it comes away, a gush of water takes place; by 
and by the child is expelled, and some time after, the after-birth 
comes away. Abortion is sometimes preceded by shivering, at- 
tended with great pains and a feeling of sickness or sinking about 
the stomach, or a tendency to faint; occasionally the patient is 
greatly troubled with wind in the stomach or bowels. But the 
symptoms vary in each case, as does the duration. In some, the 
whole process is over in six hours; in others, it is protracted for 
many days. 

The treatment of females during a miscarriage, is clear and 
simple. On the least attack, or symptoms of its approach, they 
should go to bed, with a resolve not to rise until the event is de- 
cided. If of a full habit, they should be blooded. They must 
be kept cool and quiet, avoiding every thing heating, drinking 
only cold water, or some weak tea. The bowels may be opened 
by injecting warm water. Sitting in a tub of warm water will 
always lessen the irritation of the womb. The application of 
large quantities of sweet oil around the back, belly, and breasts, 
will also have a considerable effect in allaying the action. 

When the expulsion has actually commenced, it is impossible 
to prevent the completion. The woman should keep quiet, as in 
common labour. A cold, wet rag to the belly will promote the 
contraction of the womb. Sometimes the contents of the womb 
(called ovum) lodge either at its neck or in the birth-place; when 
it is proper to introduce the finger, and move it from side to side 
for hurrying its expulsion. 

The after treatment, particularly in full habits of body, is to 
evacuate freely by bleeding and purging, with salts, cream of tar- 
tar, and oil. From neglect to do this, inflammations have come 
on, ending in lamentable derangement of these parts; as cancers, 
X 



i86 

dropsies, and barrenness. The treatment which cures the ten- 
dency of the system to abortions, is not so very certain of success. 
Before pregnancy, bleed, live low; to take regular and gentle ex- 
ercise, to avoid viol nee and excesses, to salivate, and to change 
the general habits of the body, as well as residence, are the gene- 
ral prescriptions which have done good. 

The course I would prescribe, is to revolutionize every habit, 
to eat a different diet, particularly using sweet oil; to take a new 
exercise; to arouse the system every morning by the shower bath 
of salt water, to apply the flesh-brush to the skin every night. — 
When conception has taken place, the most gentle exercise, regu- 
larity in eating simple food, and evacuating the" bowels, daily ap- 
plying sweet oil round the back and belly; to keep the birth place 
free from all irritating matter, by nightly washing in warm wa- 
ter; to bleed on the slightest feel of fever or fulness; and to pre- 
serve the breasts in a state free from irritation, by applying sweet 
oil to them and keeping them unconfined. Above all, I would 
the most earnestly recommend, as the most certain cure, to have 
the breasts drawn, particularly after an abortion. When the 
abortion has taken place, a child or grown person may suck the 
breasts, and milk will be secreted. This secretion of milk should 
be kept up for six or eight months. In one instance, in my neigh- 
bourhood, a child was taken by a lady who was subject to, and 
then had an abortion, and she raised it in good health. After a 
few months, the lady became pregnant, and, to her great joy, pass- 
ed, for the first time, to her full time for delivery. This is, un- 
questionably, the most certain mode of enabling a woman to pass 
to her full time, which has yet been discovered. 



BARRENNESS. 

Inability to conceive, is a misfortune, distressing many women 
as much as habitual abortion. It is often followed by constitu- 
tional affections, of fatal tendencies. The cure has been sought 
after with great earnestness. 

In some instances, barrenness proceeds from defective organi- 
zation. These cases are, however, very rare, and cannot be cured 
by art. The next general cause is a torpor, and irregular action 



187 

in the womb and its appendages, which often yields to judicious 
management. 

The general means of relieving this misfortune, which have 
been prescribed, are to revolutionize the system, to travel, to ex- 
cite action on the surface by the salt bath, to vary the exercise 
and habits as much as possible; and in some instances, salivation 
has been resorted to with good success. 

Viewing the subject of the propagation of our species in an im- 
portant light, I early gave it considerable attention. The theo- 
ries published on this subject, appeared too defective to be satis- 
factory. The result of my investigation, as will appear on refer- 
ence to the Medical Repository, was, that the presence of a pure, 
vital air was necessary for successful copulation, or the first ex- 
citement of animal life; that in a foul, impure air, impregnation 
could not take place. These inferences appeared the more cor- 
rect, as those who cohabit like the negroes, in open fields, at the 
sides of hills, seldom fail in impregnation. All the animals of 
creation require a similar pure air. It follows of course, that the 
connection in the foul air of beds, which will often extinguish a 
candle, is improper: that persons solicitous of success in the busK 
ness, ought always to get into fresh, pure air: that, for a like rea- 
son, when the birth-place secretes freely, it should be well wiped, 
as the secretion might absorb the pure air. 

But the great, the important means of rousing the womb, will 
be found in exciting the breasts to their natural action. The con- 
nection between the womb and breasts, has been often remarked; 
it is scarcely possible to excite an action in the one, without affect- 
ing the other. 

The most natural action for the breasts, is the secretion of 
milk. They have often been excited to the discharge, without 
pregnancy. A child losing its mother, and sleeping with a female 
friend, has been known in the night to get the nipple in the mouth, 
and to excite milk by the morning: the discovery led to the resort, 
and the child was abundantly nourished at the breast of the maid. 
Would it be indelicate or disgraceful — nay, would it not be very 
commendable, as it would be serviceable, for many single women 
to undertake this office for motherless infants? There are cir- 
cumstances in which surely it is loudly called for. 



188 

There can be no question that anv female breast may be excit- 
ed to the secretion of milk. The means are simple. The woman 
should drink freely of any liquid, and live freely. The breasts 
should be handled frequently, rubbed with the softest hand, bath- 
ed in sweet oil, and a warm poultice applied over the whole of 
them for an hour. Then it should be removed, and the breasts 
still be handled and sucked gently, at repeated intervals through- 
out the day, for several minutes. Particularly every morning, 
noon, and night, the operation should be renewed until the secre- 
tion comes. A young dog has often been used for drawing the 
breasts. When the action is excited, it should be kept up for 
months, by daily sucking them: about the time of discontinuance, 
or sometime after, impregnation may most probably be effected. 
There can be no doubt of the womb being more acted upon, more 
roused to natural action by these means, than any other we know; 
and they ought long since to have been tried. I repeat the decla- 
ration, that I have had it actually done with complete success; the 
good effects of which, in one instance, exceeded expectations. 



OF LABOUR. 

When labour commences, there are slight and flying pains over 
the belly; the womb appears to contract, or, as the midwives say, 
it falls down, or descends lower in the belly, sometimes even for 
some days previous. Gradually these pains increase, and the in- 
termission between them becomes less. The pains are produced, 
unquestionably by the contraction of the fibres of the womb, and 
differ in severity according to the peculiarity of the person; in 
some being so slight, the child has been evacuated in the neces- 
sary, without a knowledge of the birth. Many other parts of the 
body become pained, in consequence of their sympathy with the 
womb. Generally in a few hours, sometimes in less than an 
hour, the business is completed; of the rapidity of which, some 
idea may be formed by the rapidity of the pains or contractions. 

The following excellent account is from Dr. Denman. About 
the commencement of the opening of the mouth of the womb, by 
the pushing forward of its contents, the anxiety of the woman ap- 
pears to be greatest; her manner excites great sympathy, and it is 



189 

necessary the attendants should console her, and do nothing, what- 
ever may be the entreaty of herself or friends. In the beginning 
of labour, there is frequently one or more chills, called rigors, 
with or without a sense of cold in parts of the body, which being 
void of danger, and showing that the whole system is occupied in 
the business, ought not to be alarming. There is frequently an 
inclination to void urine, sometimes an inability to retain it: 
sometimes an inability to retain the excrement, and a constant 
discharge of it, which is to be indulged in the beginning, aided 
by a clyster of warm water, if convenient; care being taken not to 
sit down low for the evacuation, lest the child should be thrust 
out. If the evacuation can be had lying dow r n, it is always best. 
There is a colourless mucus discharged from the birth-place, 
which is sometimes tinged with blood, and is called a shew. 

The pains of labour return periodically, the intervals between 
them being of different continuance. In the beginning, they are 
slight in degree, and have long intervals; but, as the labour ad- 
vances, they become more violent, and the intervals shorter. — 
Sometimes the pains are alternately strong and weak, or two 
weak, then one strong; and there is reason to think that every va- 
riety has its advantage, by being suited to each patient. In every 
circumstance, continues the Doctor, which relates to natural 
labour, it is impossible not to see, and not to admire the wisdom 
and goodness of Providence, in making the power, and fitting the 
exercise, with a marked regard to the safety of both mother and 
child. This should afford a lesson of patience to those females 
who become intractable, losing their self-possession, add to the 
evils of their situation: as well as to those practitioners, who» 
being led away by popular errors, attempt to add to the strength 
of the pains, or to quicken their returns; acting as if they thought 
there was no other evil to be dreaded but a slow labour: which 
has done more mischief than the most skilful practice has done good. 

Although there be some repetition, I give the following from 
Dr. Burns, to impress the more on your minds the general history 
of labour. 

The first stage of labour is preceded or accompanied by a sub- 
sidence of the belly; and the child is often felt, even for some 
days, to be carried lower than formerly. The pains at first are 






190 

short, and come seldom. They go entirely off during regular in- 
tervals; but they often leave a considerable degree of general un- 
easiness, so that the woman feels restless and uncomfortable, or 
is hot and cold by times; and in some cases, has a sensation of 
sickness, or gripes, or a troublesome desire to make water. The 
pains are usually felt chiefly in the back; but in some cases they 
often skip to the fore part of the belly, or are from the first felt 
there. They are at first very slight, and but only for a short time, 
perhaps not half a minute, and return at the interval of fully half 
an hour; but they come on with more frequency as the labour 
continues, and are felt lower down in the back, short around to the 
top of the thighs, and cramps are also occasionally felt in the 
legs. They are also attended with an inclination to catch at, or 
take hold of a chair, or of any thing which is near. 

The pains, after a short time, gradually increase in sharpness 
and frequency; they often seem to decline for a time, after which 
they again become brisker. There is a great diversity in the 
situation and degree of the pain: for in some cases it is felt chief- 
ly in the belly, in others in the back; sometimes it is attended 
with shivering and trembling, in other cases with sickness and 
vomiting. These circumstances, though unpleasant to the pa- 
tient, are by no means unfavourable, but, on the contrary, often 
called a quick labour. 

This stage is attended with a discharge of slimy fluid, which, 
when the orifice of the womb is considerably opened, becomes of 
a red colour. These pains are often sharp, and seem to be doing 
no good, and the woman is apt to become restless and fretful; 
and as they are sometimes attended with sickness, heart-burn, 
and vomiting, she becomes impatient and depressed in her spi- 
rits. 

These pains proceed from the attempt made by nature to dilate 
the mouth of the womb, and they must continue till this be ac- 
complished. The complete dilatation is assisted and rendered 
both easier and frequently more speedy, by the protrusion, through 
the mouth of the womb into the vagina, of part of the bag which 
contains the child, and the water which envelops it. The degree 
to which it is pushed out of the womb, during a pain, varies much 
in different cases. Sometimes it forms a very slight projection; 
at others it is very bulky, as large as a child's head; when these 



191 

membranes begin to be pushed down, the water is said to "ga- 
ther." 

The mouth of the womb being considerably opened by these 
operations, efforts are next made by the system to press down the 
child, to empty the womb. These produce a change in the pains, 
which are attended with the inclination to press down. This 
gradually increases, and at last the sensation of bearing down be- 
comes very strong, almost irresistible; and it is observed, that 
though the pains be strong and forcing, they produce less com- 
plaint, than those which in the beginning of labour appeared to be 
less severe. There is a great variety in the duration of this part 
of the process. It is sometimes gradual and slow; in other cases, 
sudden and rapid. The pains may be strong and forcing, have 
very little interruption; may come on at regular periods, with 
complete intervals of ease. 

During this period, the bag, or membranes holding the waters, 
in which the child lies, usually bursts, and the liquor contained is 
discharged, at least the greater part. This event is soon follow- 
ed by an increase of the pains, which become more forcing, and 
the spirits of the woman rise in proportion. At length the head 
of the child advances to the birth-place; sometimes it seems to 
draw back; again it advances and distends the external parts 
gradually and repeatedly; this being designed for their dilatation. 
The parts dilating, the head at length passing, gives a momenta- 
ry relief to the woman. In a few minutes the pains return, the 
body of the child is expelled: it begins to cry as the air penetrates 
its lungs; the woman appears, from the release of pain, and the 
pleasure of being a mother, to have the happiest feelings. 

In a few minutes after, differing in each case, the womb con- 
tinuing to contract, the pains are felt, and the fleshy substance, 
called the after-birth, or placenta, or secundines, with the mem- 
branous bag which contained the whole, and clots of coagulated 
blood, are all expelled by a similar operation; the pains being 
half as severe as those attending the expulsion of the head. 

The duration of this process is various, but it is generally long- 
er in the first child than afterwards. This is particularly the 
case in the second stage of 1 r »our, when the external parts being 
rigid, not having been dilated, most remarkable in those marry- 
ing late, the passage of the head is delayed. Some women are 






'W 



192 

always expeditious, others tedious in the operation. Some have 
the waters discharged early, others not till the child is born. — 
Some have much sickness, as retching, shaking; others none at 
all. In short, there is a great variety in these respects with dif- 
ferent women, or with the same woman in different labours. In a 
natural labour, the whole process is concluded within twenty-four 
hours; oftentimes in a much shorter period. 

DUTIES OF ATTENDANTS. 

With this description of natural births, I proceed to speak of 
the duties attendants have to perform. In general, one assistant 
is enough, two are a great abundance, and more than three per- 
sons should never be allowed to be in the room. I shall suppose 
that no midwife can be had at the time, or if an ignorant one, that 
some lady of sense enough to understand the most simple things, 
will stand by and direct. But admitting a midwife of great con- 
ceit, or of fancied great reputation, be present, the directions are 
to be attended to; and a friend of the woman in labour should 
stand by, and not suffer the dictates of common sense to be sa- 
crificed to notions of dexterity and successful performance, which 
have slain their thousands and tens of thousands. 

The first business is to sooth the woman, to compose her mind 
as much as possible. All other animals, and women in a state of 
nature, retire to some sequestered spot to bring forth. There 
should be but little talking, that little for amusement, consolation, 
and recommending patience. The largest room should be taken 
for the operation; the bed neither exposed to a current of air, or 
the heat of a fire. Free airing is very important from the begin- 
ning to the end: nothing being more prejudicial than a confined 
atmosphere, for mother and child. 

The moment a woman conceives herself in labour, she ought to 
be dressed in the loosest clothes, of the kind that may be most 
easily removed; then to have every thing that may be wanted for 
herself or infant ready in the room. 

Instead of the parade that is made about getting the bed rea- 
dy, all that is necessary is a bed made up as others, with, on the 
part the patient's bottom is to pest, several separate cloths, so 
that the top one may be pulled away from under her, as it be- 



193 

comes dirty, leaving the next one for the upper piece: and so on 
till all are taken away. 

The articles required in the room, after baby clothes, are cold 
water for drinking, and for a bath if accident occur; any weak 
tea, or gruel, in case of its being desired; then a clyster pipe; 
warm water and soap to be in constant readiness; a pair of scis- 
sors and a little cord, or tape, or any string, to tie the navel with; 
old cloths for wiping up whatever may be offensive to cleanliness, 
or to the sight. 

OF TOUCHING. 

The first thing required of an attendant on a woman supposed 
to be in labour, is to ascertain if the labour has actually com- 
menced, an operation called TOUCHING. This is done by in- 
troducing the fore-finger up the birth-place, to feel if the mouth 
of the womb be opening. The fore-finger is introduced near the 
pubes, and then pushed backwards as a pain comes on. If the 
orifice of the womb appears to dilate during the pain, the woman 
is certainly in labour: and this is the only certain proof of its ex- 
istence. 

The best position for touching is when the woman is standing, 
leaning on the shoulder of the one feeling. It may be well done 
while she is lying on her side. It should always be done with the 
greatest gentleness^ as from violence the bag of waters have often 
been bursted, to the great injury of the case. The gentle appli- 
cation of the finger will enable one more distinctly to distinguish 
the presenting part. Some midwives have been so rough in 
touching, as to push out the eyes, and destroy the organs of gene- 
ration in the child, when such parts presented. In general, no 
oil or grease is necessary for the operation, (as formerly used,) 
since the natural secretions are unquestionably the best for lubri- 
cation. The finger being introduced, it should be held still until 
a pain is commencing, when the mouth of the womb will be felt 
opening. This dilatation of the mouth of the womb being ascer- 
tained, no more inspection should be made for some time, as fre- 
quent examination do no good, and much irritate and inflame 
trhe parts. 

Y 



194 

When the pains have frequently recurred, always, if there has 
been an evacuation of the waters from the womb, the woman 
should be touched again; sometimes the hard head of the child 
may be felt, resting against the front bones: if the waters have 
been evacuated, the hairy scalp of the child, sometimes in parts, 
folded as a cord, the openings called the sutures, and the back 
or three-sided opening, called fontanelle, sometimes the pulsation 
of an artery, may be felt. In every inspection, again and again, 
the attendant should feel most gently. 

In addition to the dilatation of the mouth of the womb, the ex- 
istence of true labour may generally be predicted from the " re- 
currence of the pains at regular intervals, by affecting the back, 
and shooting around to the thighs, and by protruding the bag, as 
a bladder of water, through the mouth of the womb." 

The actual existence of labour being established, the wo- 
man should evacuate her urine and excrement; the last will be 
best done by the aid of a clyster of warm water and soap. If the 
urine has not been evacuated for twelve hours, a catheter ought 
to be used for the purpose, unless sitting in a tub of warm water, 
or an evacuation from the bowels, produce the discharge. I re- 
peat, have the bowels well opened with an injection, because the 
confined excrement obstructs the passage of the child's head, and 
causes the parts of the mother to be destroyed by the compres- 
sion; because, unless this be done, there is an evacuation at birth, 
so offensive as often to interrupt the operations of the attendants; 
and because it proves of great service to the woman after labour. 
Indeed, you will save yourselves much suffering, if you will at- 
tend to the injunction of emptying your bladder and bowels on 
the approach of a delivery. 

The directions for a woman to observe when labour has com- 
menced, are various; but those most consistent with common 
sense are the best. Dr. Burns says, that, in the first stage of la- 
bour, the patient may stand, walk, or sit, or remain in bed, as she 
is inclined; but by no means stand as long, or walk so much, by 
way of forwarding the labour, as is productive of fatigue. Women 
should always be impressed, that a slow labour is much less injurious 
than those which are quick. When the pains become frequent and 
pressing, she should keep to her bed. 



195 

Before the child is delivered, there is often a strong desire to 
rise to go to stool, but not to be indulged, as the child might, 
with great danger, be born when the woman rises up. Some- 
times it has been born in the pot! 

Fretting should be avoided as much as possible. All voluntary 
attempts to press down, called bearing down, must — must be 
avoided, as by expediting the passage of the head before the di- 
latation is effected, the parts might be miserably torn. 

After the head of the child descends in the birth-place, the ex- 
ternal parts begin to obtrude, and great attention is necessary to 
guard against injury. An account of all ills brought on by in- 
terfering in this stage, would appear incredible. All parties 
seem, in this stage, to unite in doing the wrong of hurrying the 
birth. The woman should be confined to her bed. Her best po- 
sition for all parties, is lying on her side, legs drawn near the bel- 
ly, and a pillow between the thighs. Talk to her, to prevent her 
bearing down. Keep the hand applied between the fundament 
and birth-place, (part called perineum). The pains in this stage 
of labour, are called bearing or forcing pains; as the woman, by 
her exertion, bearing down, forces, most improperly, the delivery. 
As the head advances, push your hand with a force equal to about 
pushing forwards a ten-pound weight. If the head be coming 
too rapidly, extend your hand, so as to delay its passage, for a 
pain or two pains more; tell the woman not to bear down; and 
still, as the child's head passes, keep the hand pressing against 
this perineum, so as to incline the child's head forwards, towards 
the pubes. The head having passed, the perineum retracts; a 
respite is felt. The body of the child is not then to be touched: 
the pains of the mother will soon expel it; they alone are to do 
it. The hand is to be kept on the perineum, as the shoulders 
and hips pass, pressing as before, though with less force. 

The child being thus born by the powers of the mother, it is to 
be left, its head free for fresh air, during its crying; it is not to 
be touched for some time. When the pulsation of the navel cord 
begins to lessen, after eight to twenty minutes, tie it within two 
or three inches of the child's navel, with any kind of string, mo- 
derately tight; then tie it again, two or three inches from the 
last knot, towards the mother, in like manner; the cord between 



196 

the knots to be cut in two with a knife or scissors; always look 
while doing this, lest some parts may be cut which should not be. 

The child being handed over to be washed in warm water, and 
to be dressed in the most free, loose, easy, possible manner, the 
woman is to remain quiet. The after-birth, or placenta, and 
membranes, are to come away; and soon the womb contracts, the 
pains return, and the whole is expelled. If it be detained longer 
than thirty minutes, the belly is to be rubbed; the woman may 
roll over in bed to the other side; the cord may be pulled a little 
during a pain, with a force equal to one pound. Some robust 
persons have been advised with success to stand up a minute or 
two; these means not succeeding, a cold wet rag applied to the 
belly will excite the action: lastly, the finger may be pushed up 
the birth-place, and being turned around the sides of the womb, 
excites it to contraction. Remember, the object is not to drag away 
the after-birth, but it is to cause the womb to contract, to expel it.-— 
If there be much loss of blood, cold water to the belly, by means 
of wet rags, and pushed a little way up the birth place, will stop 
it; fainting is to be encouraged, not hindered, as during fainting 
the bleeding is checked. 

The after-birth being discharged by the contracting power of 
the womb, the woman is still to be kept reclining; and being 
wiped dry, is to be rolled over to the dry and other side of the 
bed; turning over is best; she may be lifted as she lies, but should 
not elevate herself. Any succession of cloths may be pushed 
under her: and between her thighs, at the birth-place, a rag is to 
be applied, to absorb the discharge that follows. 

Thus, you must be struck with what inconsiderable offices are 
to be performed by midwives. A great point is, to know when 
not to act, which very few have learnt properly. In almost every 
case, in this country, excepting when a physician is wanted to 
prescribe for the constitution, they may be summed up as follows, 
and ought to be committed to memory by every female: 

" To have the woman's urine and excrement well evacuated in 
the beginning; to keep her composed and quiet; charging not to 
exert her voluntary powers, as the work is best done by the in- 
voluntary ; to be careful not to burst the bag containing the waters, 
by fingering; not to be too constantly fingering the parts. When 



197 

nearly ready for delivery, to keep her lying on her side: knees drawn 
upwards, and opened by a pillow between them. As the child's 
head advances, and distends the parts about the fundament, to keep 
the palm of the hand ready to press as the head protrudes, press- 
ing equally and gently on the perineum, so as to incline the head 
forwards, towards the front or pubes; and when, as the child ap- 
pears to be advancing very rapidly, threatening to pass before the 
parts are opened, to incline the hand more forwards, so as to delay 
its passage for a pain or two; in this stage particularly, entreating 
the woman to be quiet; to let the child's body be expelled by the 
powers of the mother; of the cord, be sure that it is not compress- 
ed or tightened; and in ten or twenty minutes, when its pulse 
ceases, tie it in two places, two or three inches from the navel, then 
towards the mother, and cut it between the knots; to wait for the 
after-birth; if it do not come away in thirty or fifty minutes, to roll 
the woman on her belly and back again; to rub the belly with the 
hand, and to pull the cord with a force not exceeding one pound 
weight; to excite the womb to contraction; lastly, in an hour, ap- 
plying for a minute, a cold, wet rag to the belly, another to the 
birth-place, and always doing this when there appears to be a 
great loss of blood. The woman to be rolled over, wiped dry, and 
put in her place for repose." Duties which can be done by the 
lowest servants, and not disgraceful, if performed by the highest, 
to a suffering mother. 

I will now make a few questions and give their answers, the 
more effectually to impress on your minds the offices to be per- 
formed at labour. 

Q. What is the first thing a woman in labour should attend 
to? A. The evacuation of the bladder and bowels, in order to 
prevent the compression and injury of these parts. 

Q. What ought the attendant first to do? A. Introduce the 
finger up the birth-place, and gently, during a pain, feel the open- 
ing of the mouth of the womb, in order to pronounce certainly 
whether the labour exists. 

Q. What will she feel on introducing her finger? A. Proba- 
bly the bag of waters, like a bladder, which she is to touch so 
gently as not to endanger bursting; if the labour has not advanc- 



198 

ed, she only feels the mouth of the womb gradually dilating at 
each pain. 

Q. When the waters are discharged, what should the attend- 
ant do? A. Examine or touch the woman again, so as to fee! 
what part of the child presents at the mouth of the womb. 

Q. Finding the hard bones of the head, probably the hairy 
scalp, folds of the scalp, and observing, probably, the pulsation 
of some artery of the head; what should be done? A. Nothing, 
but keep the woman in bed, her legs drawn up, a pillow between 
her thighs, so as to give room for the passage of the child, and 
to allow its head to rest on delivery. 

Q. What is the difference between the pains, when the mouth 
of the womb and external parts are dilating? A, When the mouth 
of the womb dilates, the woman feels more excruciating pains, 
called grinding, rending, and cutting pains. When the external 
parts dilate, she feels bearing, forcing pains, as if the external 
parts were bursting. 

Q. What are you to do, when the last pains come on? A. Keep 
the woman in bed, the right hand against the part called perine- 
um, between the fundament and birth-place; earnestly entreat the 
woman not to bear down — to amuse herself with talking; lastly, 
as the head advances, press firmly against the perineum, so as a 
little to incline the child's head towards the front or pubes, in or- 
der to support this perineum. 

Q. What is the difference between the perineum in this stage, 
and when not distended? A. In a common state, it is about an 
inch wide; at the passage of the child, it expands greatly, and 
becomes very thin — so thin, that by hurrying the passage of the 
child's head, it has been torn, leaving the lower gut and birth- 
place as one opening. 

Q. How is this to be avoided? A. By not hurrying the labour; 
by holding the hand against it, so as to support it; by resisting, 
with the same hand, the passage of the child's head, for one or 
two pains, if it appear to be coming very fast. 

Q. When the child's head is expelled, what are you to do? 

A. Let the head lay supported at the side, and do nothing un- 
til the pains of the mother expel the body: during the expulsion 
of which, the hand is to be still kept supporting the perineum. 



199 

Q. After the expulsion of the child, what is to be done? 

A. Remain quiet, after allowing fresh air for it to breathe, 
until the pulsation of the navel cord has lessened, and the child 
freely breathes. This is generally sufficient in ten minutes: and 
then, with any string, the cord is to be tied near the navel, within 
a short distance, and cut between the knots. 

Q. After the separation of the child, what is next to be done? 

A. Let the woman remain quiet for a few minutes; then feel 
her womb through her belly, to see if it is contracting, to expel 
the after-birth. If it do not contract, the belly is to be gently 
rubbed, and the navel cord a very little moved, to excite the 
womb to contraction. 

Q. Are you in any case to pull the after-birth away by the na- 
vel cord? A. By no means: as the object is not to take it away; 
but to make the womb discharge it by its contractions. 

Q. What other means are there for exciting the womb to ex- 
pel the after-birth? A. Turning the woman over on her belly; 
then introducing the finger to the mouth of the womb, and turn- 
ing it around its edge, to excite its action; at the same time gen- 
tly extending the cord, so as to aid in producing the contraction. 
Strong women, who have not lost blood, may stand up, leaning 
the head and body over the operator. Lastly, if the after-birth 
do not come away in one hour, the hand may be introduced in the 
birth-place, and the fingers extended all around the edge of the 
womb, to make it contract; and then insinuated between the edges 
of the after-birth and womb, slowly separating them, if they ad- 
here, as the contraction goes on. 

Q. If there should be an alarming discharge of blood, how 
would you stop it? A. By applying a cold, wet rag on the belly, 
and pushing another a little up the birth-place. 

Q. What are the evils of pulling away the after-birth? 

A. The separation being made before the contraction of the 
blood-vessels, profuse bleeding ensues; and if the adherence be 
great, the womb may be torn from its connections. 

Q. The after-birth being removed, what next? A. The wo- 
man is to be wiped dry, turned or rolled over to the other side of 
the bed, with a dry cloth at the birth-place; and with fresh air, 
without a current, is to be left to slumber quietly for a few hours. 



300 

Recapitulation of natural labour from Dr. Meriman. It is di- 
vided into four stages. First stage, the head of the child passes 
through the upper brim of the pelvis, and the mouth of the womb 
dilates the size of a crown. Second stage produces that change 
in the position of the head, which turns the forehead into the hol- 
low of the back bone, (os sacrum) and brings the crown of the 
head to emerge under the pubes in front. Third stage produces 
the expulsion of the child from the external parts. And the 
fourth stage, the after-birth is delivered. 

(Note.) The mouth of the womb opens fully, sometimes in 
the first stage, at others not till the second stage is over. The 
time at which the membranes rupture is various. The longer 
they remain entire, the safer in general is the labour: the most 
natural being when the waters are not evacuated till the head of 
the child is just ready to pass into the world. 

BEGINNING SYMPTOMS OF LABOUR. 

First: General and equal subsidence of the womb and belly; a 
very favourable symptom. Second: A discharge of a mucus fluid 
from the birth-place, called a shew, when tinged with blood. 
Third: Frequent gripes, and desire to evacuate the bowels. And 
Fourth: A frequent urgency to make water. 

OCCURRENCES DURING LABOUR. 

Pains, restlessness, despondency, rigors, vomitings, profuse 
perspiration. 

Pains are true or spurious. The spurious are known by irregu- 
lar occurrence, by affecting the belly more than the back or sides, 
and by not opening the mouth of the womb. True pains are 
known by recurring at regular intervals; by affecting the back, 
and shooting round to the thighs; by producing a perceptible 
opening of the mouth of the womb during each pain; and by pro- 
truding the bag of waters as a bladder, through the mouth of the 
womb. 

True pains are of two kinds. 1st. Grinding, rending, cutting, 
as the mouth of the womb dilates. 2d. Bearing, or forcing pains, 



201 

after the womb has opened, and the bag of waters, or the head of 
the child, is forced through the mouth of the womb and the ex- 
ternal parts of the mother. 

The restlessness and despondency of women in labour, occur in 
the early stages, during the grinding pains, generally relieved 
when the bearing pains come on. 

Rigors or thrillings often occur during the opening of the mouth 
of the womb, and when it is completed; sometimes preceding 
the passage of the head through the external parts; and terminate 
by producing violent cramp in the lower extremities. These are 
favourable indications of labour, different from those distinct shi- 
vering fits, the forerunners of fever, occurring in long, difficult 
labours. 

Vomiting is also a favourable symptom in labour, at the begin- 
ning; but should create alarm, when it occurs after a long con- 
tinuance of labour, the mouth of the womb opened, and pains 
suspended. 

Persjiiration is a natural consequence of labour; but artificial 
perspiration, brought on by heated air and bed clothes, or heated 
liquors, is injurious. 



RULES FOR MANAGEMENT OF NATURAL LABOUR. 

1. Natural labour requires but little assistance. The dilata- 
tion of the soft parts is effected by the pains, assisted by the bag 
of waters; of course, no attempts to dilate must be made by the 
attendant. 

2. During the first and second stages, the patient may sit, stand, 
kneel, or walk about, as she pleases; repose occasionally on a bed 
or couch, but not too long at a time. 

3. She should be supplied with mild, bland nourishment, if de- 
sired, in moderate quantities. Tea, coffee, gruel, barley-water, 
milk and water, lemonade, broths not salted, may be allowed; but 
beer, wine, spirits in any form, should be forbidden, as injurious 
in the early stages of labour; and only used in small quantities in 
the last stage, in cases of great exhaustion. 

4. Bladder and bowels, by all means, to be emptied after intrc- 
during the finger into the birth-place. 

Z 



5. Touching must be resorted to, in order to judge of the pro- 
gress of labour; not too often repeated, and with great care not 
to break the membranes. 

6. The spirits of the patient to be kept up by cheerful conver- 
sation; not noisy or unpleasant remarks. 

7. About the end of the second stage, the patient is to lay 
down; legs drawn to the body; knees opened with a pillow; the 
attendant to be behind, ready to support the part between the fun- 
dament and birth-place, as the head and body pass; to retard it 
one or two pains, if too rapidly coming; and after the head passes, 
allow the pains to expel the body. 

8. After the child breathes freely, in ten or fifteen minutes, tie 
the navel cord, one or two inches from the belly, another within 
four or five inches, and divide the middle: examining as it is done, 
to prevent cutting improper parts. 

9. The child being born, secondary pains come on, to expel 
the after-birth: these, generally in less than twenty minutes, expel 
it in the birth-place, from whence it is extracted easily. 

CAUTIONS TO ATTENDANTS. 

From the history of labour, we learn that the object of the slow 
returning pains, is the gradual opening of the parts for the pas- 
sage of the contents of the womb. To say nothing of experience, 
can you fail to perceive that hurrying the operation must tend 
to burst the parts? Indeed, for a woman to suffer a midwife, 
without any cause, to be thrusting her hand up her womb, tugging 
at the parts, exciting irregular action and irritation; for her to be 
prevailed on to bear down, forcing, striving to discharge the 
child, all show, that she no more exercises her common sense, 
than such officious, meddling mid wives. A contrary treatment: 
patiently waiting for the involuntary contractions to do the busi- 
ness, and when appearing too rapid, to press with the hand on the 
distended parts, then so thin, that is, the perineum, so as to sup- 
, port it, (and not to tear it open with the fingers, or slip it off, as 
some have been known to do,) is the course pointed out by com- 
mon sense. To guard against this accident, in addition to the 
above means, the mucus should never be removed from the parts: 
and when dry, they are to be well oiled. 



208 

When the perineum, or part between the birth place and fun- 
dament, has unfortunately bursted, the parts should be well wash- 
ed, and freed from any thing that can keep their edges apart. A 
clyster should immediately be given, if the bowels have not been 
cleansed before delivery. The thighs should be drawn up, the 
knees kept close together, the parts at perfect rest; any mild oint- 
ment may be applied externally. Sometimes these lacerations 
have thus healed up, though often otherwise; leaving the excre- 
ment perpetually entering in the birth-place. 

Pulling down the womb, and floodings in labour, are produced 
by as unnatural treatment, as much in violation of common sense, 
as the bursting of the perineum. Every woman would instantly 
bleed to death, if, on the separation of the after-birth from the 
womb, it did not contract, so as to stop up the mouths of the 
large vessels which carried the blood to the after-birth. I repeat, 
then, the great business is, not to extract the placenta, not to pull 
at it, (sometimes even the cord has been pulled off, in the abomi- 
nable exertion,) not to force it away, as has been so generally 
done, but to excite the womb to contract and expel it. Common 
sense should teach that this pulling away, must either pull down 
the womb, or separate the after-birth before the womb contracts, 
and must produce floodings, and therefore ought not to be sub- 
mitted to. The means of exciting the womb to action in com- 
mon cases have been mentioned. They should be continued after 
a pain, the cord gently pulled (again remember, not to pull it 
away, but to excite the action of the womb); finally, the hand may 
be introduced up the womb, the fingers rubbed against the sides, 
around the edges of the after-birth; lastly, the careful midwife is 
to insinuate her finger all around its edge, slowly separating it; 
and with a cold, wet rag on the belly; rubbing the belly, pressing 
gently, and moving about the great ball or mass of the womb, its 
contraction will be promoted. A general rule is never to remain 
more than two hours without expediting the delivery by the above 
means. The hand going into the womb, is guided by the navel 
cord; when the whole is brought away, it should be so turned, or 
wiped around, as to take up the membranes and clots of blood, 
which may adhere to the sides, and produce after-pains. 

Whenever there is an alarming loss of blood after delivery, 
cold water is to be applied; a bag of fine ice or snow has been 



204 

stuffed up the birth-place, and applied to the belly, with success. 
You are, unhesitatingly, in cases of danger, to pour on a pitcher 
of cold water, and inject cold water up the birth-place with a com- 
mon syringe. It is almost needless to add, that the patient should 
have fresh air, no heating drinks or covering; and is to be wiped 
dry, and moved as little as possible. Pushing up the birth-place 
powdered charcoal will be found a valuable remedy, in expediting 
the contraction of the blood-vessels and coagulating the blood in 
them. 

TWINS. 

The directions you have now had, relate to almost ninety-nine 
cases in the hundred of births, according to records kept of deli- 
veries, at various lying-in hospitals. If you attend only to this 
proportion of cases, you will do much good indeed. But I would 
wish you to do more: I would have you attend to the remaining 
cases; to form at least such a knowledge of each possible varia- 
tion, as will enable you to understand the treatment, or to direct 
an attendant, in case of inability to procure a physician to consult 
with when wanted. But, truly, in most of these unusual cases, 
the powers of nature are fully equal to disburden the womb of its 
contents. I will not indulge the fear that you will be so fanciful 
as to suppose that each irregularity will happen to yourself.—* 
Therefore, I state that sometimes more than one child is born at 
a birth; and that the child occasionally presents different parts of 
its body at the birth-place. 

Dr. Merriman has summed up the useful information for the 
management of twins, as follows: "It is seldom (says he) possi- 
ble to ascertain that there are twins, till after the birth of the first 
child; yet, very rarely, it is known during the first labour, by the 
membranes of each child being felt at the same time in the birth- 
place; and sometimes different parts of the two children come 
down together. 

Each of the twins is commonly smaller than a single child, 
Which occasions often the birth to be rapid; and gives the first 
idea of the twins. At other times, though it is evident the child 
be small, and there is room for it to pass; yet the pains, though 
frequent, do not propel it, as the action is impeded by the child 



205 

at the upper part of the womb. After the delivery of the first 
child, by feeling the belly, the existence of another child may be 
ascertained. If the womb feel very large, rather than leave the 
woman in uncertainty, it is advised to introduce the hand in it, 
and feel for the child. Generally in twin cases, the second child 
is delivered in an hour after the first, and in a position contrary to 
that of the first; so that if the first present head foremost, the se- 
cond is a breech or feet presentment. 

The first child being delivered under the management prescrib- 
ed for single cases, some time ought to be allowed to recruit the 
woman's strength, and to give an opportunity for the second la" 
bour to come on spontaneously. There are many cases, in which 
it would be unadvisable to wait so long as four hours, without in- 
terference. 1st. When artificial aid was requisite for the first 
delivery. 2d. When the child presents unnaturally. 3d. When 
fits or flooding come on. In either of these cases, the labour is 
to be finished before four hours. 

The following is an outline of the practice which I have been 
in the habit of adopting: 1st. When both children present na- 
turally, and the labour of the first terminates without aid, and 
without much fatigue to the patient, I wait for the secondary 
pains; but should these not come on in a reasonable time, (four 
hours,) I introduce my hand, and rupture the membranes; when, 
commonly, the second child passes readily through the pelvis.— 
2dly. If the first labour has been natural, and the second child 
presents in a wrong direction, I have generally deemed it expe- 
dient, with very little delay, to extract it by the feet. 3dly. If 
the first labour has been unnatural, with but very little delay, the 
membranes are to be ruptured; and whether the child should be 
brought down immediately, and delivered by the feet, or not, the 
attendants must decide. The rules applicable to cases of twins, 
will equally apply to cases where there are three or more chil- 
dren." 

After the delivery of twins, greater care is necessary to prevent 
the mother's fainting, than in single births: she should not have 
her head elevated; and in moving, should be rolled over in the 
bed. It will be more proper to apply a bandage, in these cases, 
to support the belly. The rules respecting the delivery of the 
after-birth, are the same as in other cases. 



206 



BREECH AND OTHER PRESENTMENTS. 

Cases of the child presenting with its breech foremost, are 
not very uncommon; occurring, perhaps, rather more frequently 
than twins. The signs of breech presentment are not very cer- 
tain at the commencement. In general, it may be ascertained by 
the soft flesh, and globular shape of the presenting part, by the 
cleft between the buttocks, by the parts of generation, and by the 
evacuation of the contents of the child's bowels, called meconium; 
which last, however, takes place at other presentments. 

The progress of this labour is generally, particularly in the be- 
ginning, more slow than presentments of the head. The thighs 
and feet of the child are drawn up close to its body; and in its 
passage through the pelvis, the navel cord being compressed, the 
death of the child is very apt to occur. Delivery in these cases' 
is generally effected by the powers of the mother. At first, 
while the breech remains above, nothing but patience is neces- 
sary; when it passes out of the external parts, the perineum is to 
be supported with great attention, as it is more apt to burst in 
these cases; particularly as the heels pass, they are very apt to 
produce the laceration. As soon as the navel cord appears at the 
navel, it should be pulled down a little, to lessen the stretching. 
In this situation, every thing should be done to hurry the delive- 
ry, which is consistent with her safety. The compression on the 
cord soon causes the death of the child, which may be remarked 
by its convulsive, tremulous motion. The belly should be rub- 
bed, gently pressed, to excite pains. As soon as the arms ap- 
pear at their shoulder joint, the finger should be introduced over 
the shoulders of the child, as far as to the bend of the elbow, and 
then gently depressed, when the fore arm passes readily into the 
birth-place; the second arm will be more easily extricated. The 
body of the child is then to be gently extended, in the direction 
it appears advancing; not powerfully, as death will be produced 
by the destruction of the back-bone. When the neck appears^ 
the finger may be pushed up around the mouth of the womb, and 
moved or rubbed a little against the edge or sides of the cavity, 
in order to hurry a return of pains. As soon as the mouth can 
be reached, a finger should be introduced in it, and the chin pull- 



207 

ed down, to expedite the birth, at the same time that air may en- 
ter its mouth. Strong women may stand up, or kneel, in these 
cases, to hurry the delivery. 

In some cases, the child presents with its breech situated dif- 
ferently from the above; so that the face is towards the pubes: 
and as the chin may lodge against them, and retard the labour, 
the attendant should turn the belly of the child to the best direc- 
tion. When the breech is delivered, and the toes are towards 
either hip of the mother, the child is in a right direction. But 
if the toes point to the pubes, or b.lly of the mother, the head will 
come in an unfavourable position; and therefore it will be proper, 
as soon as the breech is delivered sufficiently, to take hold of the 
thighs with the two hands, and when the next pain comes on, so 
to turn the body, or give it such a slight inclination, by guiding 
it with the hands, as will direct the face towards the mother's 
spine. 

There is no difficulty in effecting this turn, if it be done pru- 
dently and cautiously. Much force is not required; nor is it ne- 
cessary that the child's belly be turned quite round to the mo- 
ther's back; an inclination towards the mother's back is all that 
is wanted. 

In cases where the, mother has a large, well-formed pelvis, the 
child may certainly be delivered living; but the chance is very 
indifferent, when the pelvis is narrow, or any thing occurs to re- 
tard delivery. I should recommend, whenever a breech present- 
ment can be ascertained to exist, to send for some experienced 
hand; or, at all events, the united sound sense of the bystanders 
must be exerted in defending the perineum of the mother from 
laceration, and the child from death, by delay in the pelvis. To 
this I will add, that the efforts to re-animate the child, by blowing 
down its nostrils, rubbing its skin, bathing in hot water, should 
be continued two hours at least, as life has been restored in seve- 
ral cases of longer duration. 

The next presentments of children at birth, are the knees, and 
the feet. Sometimes either one foot, or one knee. The knee 
may be ascertained by its bluntness; the foot by its thickness, the 
heel, the great toe, shortness of the toes, and their forming near- 
ly an even line. 



£08 

The treatment in these cases is precisely the same as that of 
breech presentment. If the child do not present so that its face 
shall be towards the back of the mother, its body is to be a little 
inclined towards it, as soon as the breech is delivered. The na- 
vel cord is to be guarded from extension, and the birth, after the 
navel passes, to be hurried as much as possible; though all these 
cases are to be left to nature, until the navel passes. In these ca- 
ses, the greatest possible care is to be taken not to burst the bag 
of waters, which will hinder the dilatation, so particularly requi- 
site in such presentments. 

You have now the history of the births upon a fair average of 
nine hundred and ninety-nine cases in the thousand. You per- 
ceive the offices to be performed by attendants, in all these cases, 
amount to almost nothing; chiefly to not breaking the membranes; 
applying the hand to the perineum, to support it; and, in possi- 
bly one case in many hundreds, inclining the body a little around, 
so as to turn the face towards the back of the mother, when, as 
so rarely happens, the toes are towards the belly of the mother; 
and lastly, in hurrying the labour, when the navel is delivered, by 
telling the mother to bear down; by rubbing the belly, and by a 
gentle pulling of the body in the direction it advances. 

Although I consider any further detail to you on the subject of 
midwifery, as unnecessary for useful purposes; yet as it may tend 
to gratify curiosity, and possibly be a subject of reference by some 
practising midwife, I proceed to state the remainder of the cases 
occurring. 

It is probable that there is not one part of the infant's body 
which has not, at some time or other, presented at the mouth of 
the womb for delivery. The rules to be observed, in such cases, 
I shall continue to extract from Dr. Merriman. 

The irregular presentations of the head, are when the forehead 
is towards the pubes, or belly of the mother: when the face pre- 
sents: when the hand or arm enters the pelvis with the head. 

1. The most common of the wrong head presentations, is that 
of the forehead to the pubes. It is seldo a discovered at the first 
examination; the labour continuing longer than usual, the atten- 
dant makes a more accurate examination, ;.nd discovers the pre- 



£09 

Renting part is not so conical at the union of the pubes in front; 
the bones do not ride one over the other; the scalp does not form 
into a cushion; the hollow of the sacrum is not so filled up by the 
head; the front fontanelle, with its square shape, and four seams 
or sutures, at each corner, may be felt. Nature, in general, par» 
ticularly in those of large pelvis, will deliver in this presentment; 
but there will be danger of laceration of the perineum, and the 
labour will be tedious; all will be prevented, if the attendant will 
apply the fingers to the side of the forehead of the child, and care- 
fully press the fontanelle from the thigh bone, it approaches, a 
little around, to the side or edge of the sacrum, whereby the 
crown of the child's head (occiput) is brought under the pubes 
in front, and the delivery is safely effected by nature. 

2. The presentation of the face is distinguished by the general 
inequality of the presenting part, by the eyes, nose, mouth, and 
chin; the chin, in these cases, is towards the front of the pubes. 
These cases are generally to be left to nature; the bones not yield- 
ing, the labour will be tedious; the children generally born alive, 
but the features of the face are amazingly distorted, and require 
several days of rest for recovery. 

3. When, with the head, one arm presents, nature generally per^ 
forms the work but slowly. This irregularity occurs chiefly in 
those of wide pelvis. If it be only the fingers or hand, coming 
down in a flattened shape, by the side of the head, the difficulty 
will not be very great; if the elbow be the part, its fore arm bent 
on the upper arm, the difficulty will be increased; and still more, 
if the hand and arm have descended before the head, the head 
resting upon the arm at the elbow. 

Occasionally the operator may with the fingers prevent the 
hand or arm from descending below the brim of the pelvis, till 
the head progresses so low, as to be clear of the impediment; but 
in attempting this, if the operator bring the arm down lower, or 
force the head back, no good, but great danger will be done. It 
will be very practicable to push back the hand with a finger, with- 
out pushing back the head, or pulling out the arm. The arm, in 
these cases, in general is much tumefied, but in a few days reco- 
vers itself. 

In these cases unusuai care must be taken to keep the patient 
calm, free from fever, cojI, not sweating under hot clothes, and 
A a ta 



210 

guarding against fatigue in vain attempts to force the child, before 
the parts are properly prepared to let it pass; opening occasion- 
ally her bowels with laxatives; and never allowing the urine to re- 
main in the bladder; to which, in these cases, it is particularly in- 
clined. 

The next presentations are, first, those of the superior extremi- 
ties; second, the back, belly, or sides; and third, the navel cord. 
These cases are only to be ascertained by feeling up the birth- 
place. 

If, on examination, the mouth of the womb be dilated, and the 
child cannot be felt; if the waters be evacuated, and the child out 
of reach of the finger, the probability is increased of an unnatural 
case. 

1. The most difficult cases are those of the superior extremi- 
ties; for, whether the part be the hand, elbow, shoulders, or both 
hands, it is impossible for the child to be delivered without being 
turned, and delivered as a footling case. The established prac- 
tice is for the operator to pass the hand in the womb, to take hold 
of a foot, both if practicable, and bring them down to the external 
parts, and conduct the delivery as if it had occurred naturally. 

The rules, in these cases, are, first to let the bag of waters di- 
late the parts. As soon as the mouth of the womb is sufficiently 
opened, or the waters evacuated, the attendant is gradually to di- 
late the external parts, till they make no further resistance to the 
passage of the hand. Then slowly carrying his hand through 
the birth-place and mouth of the womb, in the absence of a pain, 
he must (if they have not been opened) rupture the membranes, 
by pressing a finger firmly against them, when the hand will 
come in contact with the limbs of the child; the hand is then to 
pass forwards till it reaches the feet, which are to be drawn along' 
the belly, not over the back of the child; proceeding slowly, still 
in the absence of a pain, it will be found, as the feet are brought 
lower, the arm will be retracted; and lastly, when brought down, 
that the case is become as a foot or breech presentment; of which 
it must be particularly remembered, to turn the feet towards the 
sides of the mother, in order that the face may pass at her back. 
These are the safest cases; generally the waters are evacuated be- 
fore the hand is introduced to prevent their passage; and the 



211 

womb contracts around the child, so as to make great resistance 
to the introduction of the hand. In such cases, and when the 
mouth of the womb is not dilated, the patient ought to be blood- 
ed freely, if she can bear it, to lessen the contraction; and imme- 
diately after, (the better if fainting exists,) the mouth of the 
womb is to be dilated, and the hand insinuated as above. Lastly, 
when the action of the womb is so violent as to make great re- 
sistance to the hand, it has been advised to wait, till the pain ex- 
hausts its powers. Dr. Hamilton prefers doing this, by adminis- 
tering eighty drops of laudanum. I would always advise free 
bleeding, and bathing the parts, in large quantities of sweet oil, 
or melted hog's lard, and to keep warm, wet cloths around the 
parts, to be often wrung out of warm water; if not, to bathe the 
whole person in warm water, sufficiently long to produce a gene- 
ral relaxation. 

2. The next presentations are those of the back, belly, and 
sides. In these rare cases, the child often spontaneously turns 
into a breech presentment. When it does not, the introduction 
of the hand is necessary, to bring down the feet. 

3. The presentment of the navel cord. In these cases, the cord 
falls down, before the child, and is compressed, so that the death 
of the child is generally the consequence. When the pulsation 
of the cord ceases, the child dies. Sometimes the cord has been 
slipped back out of the way of compression. If this cannot be 
done, and the child be living, after the part of the child is en- 
gaged in the brim of the pelvis, the labour is to be hurried, by 
letting the woman stand up, by rubbing the belly, and by bearing 
down. 

• 
In order to impress on your minds the more what has been 
said of labour, I recapitulate. 

1 . If the after-birth be not delivered in about an hour and a 
half, after the use of the gentle means first suggested, the hand is 
to be introduced into the womb; the fingers to touch and move 
against the sides; then the after-birth to be separated slowly, and 
brought away during the contraction of the womb. 

2. In cases of twins, nothing extraordinary is required in com- 
mon; if the second child be detained four hours, delivery to be 
forced as directed. 



21& 

3. In breech presentments, the beginning to be left to nature: 
the presentment to be ascertained by the feel, the cleft between 
the buttocks, and the parts of generation, and discharge of con- 
tents of the bowels. When the heels pass, great care is to be 
taken to support the perineum; the slower the labour so far, the 
better; then as the body passes, pull a little the cord; moderately 
extend the child, not so as to destroy its back and neck; rub the 
belly occasionally; let the woman bear down; let her stand up, 
leaning forward, that an attendant may properly support the 
child; when the arms appear at their origin, to pull them down 
gently; rub the finger around the edge or the mouth of the womb, 
to excite it to contraction; lastly, when the child's mouth ap- 
proaches, introduce the finger, and pull down a little; as soon as 
delivery, the woman to lie down; the child so supported as not 
to be injured; air to be blown in its nostrils, if not breathing; the 
cord to be cut; the skin to be rubbed, and every attempt made, 
and long continued, to reanimate the body. 

The standing up of the woman, as above, will probably hurry 
the birth with sufficient rapidity; and I would particularly charge, 
that the child be so supported in its passage, as not to be endan- 
gered by the position; its weight, properly directed, must have a 
considerable effect in expediting the birth. 

4. When the feet present, to be ascertained by the heel, the 
shortness of the toes ? their straight edge, &c; and when the 
knees present, to be ascertained by the bluntness of the angla 
they form; or when one foot, or one knee presents, the delivery to 
be effected as in breech cases, toes turned towards the thighs, on 
the passage of the breech. 

5. When the forehead presents, ascertained by feeling the 
front, or square opening, or fontanelle, with its four seams or su- 
tures, and the cavity in the back or hollow of the sacrum, to ap- 
ply the fingers to the side of the forehead, and turn or incline it 
around from the thigh bone of the mother, towards the edge or 
side of her back bone, or sacrum, where it unites to the hip bones, 
So that the presentation becomes natural, which it often does, 
even without assistance. 

6. When the face presents, to leave to nature, preserving the 
powers of the mother, without excitement or molestation^ keeping 
her cool and comfortable as possible. 



213 

7. When the hand or arm presents with the head, to endeavour, 
without pushing up the head, to push back the arm, (never to 
pull it forwards,) and, if not successful, still leave to nature. 

8. When one or two arms, the back, shoulder, belly, or breast, 
present, as soon as ascertained, and the membranes have opened 
the mouth of the womb, slowly introduce the hand, search for 
the feet, bring them down over the child's belly; thereby making 
a feet or breech presentment. When the womb contracts so vio- 
lently as to make great resistance to the entrance of the hand, the 
woman to be blooded freely, bathed around the body with sweet 
oil, fomentations of warm cloths to the belly, or general warm 
bath, to produce relaxation. Lastly, a large dose of laudanum, 
not exceeding eighty drops. 

9. When the navel cord presents, if early discovered, some- 
times it may be so pushed back, as to lessen its compression. — 
The delivery to be hurried, to save the child, but not so as to la- 
cerate the mother. The shortness of the navel cord is also some- 
times an impediment to delivery: art does not here promise 
much; the cord has been cut, and the child died; the after-birth 
generally comes with the child. 

j| You must believe that there is nothing in these uncommon ca- 
I ses, which a woman of good, sound sense, cool, composed, not in 
a hurry, could not perform. I would, in full confidence, trust to 
any such, especially if directed by a by-stander in what manner 
to proceed, and directing from established rules. Nevertheless, 
where no such confidence exists, I would advise an application to 
a physician, where there are grounds for apprehending a tedious 
labour, 

DIFFICULT LABOUR, FROM THE MOTHER. 

Having stated the difficulties of labour at births, arising from 
the irregular presentment of the child; I have to remark, that 
they are probably not more than half so numerous as those at- 
tendant upon child delivery. The capacity of the mother is as 
liable to variations as the presentation of the child, proceeding 
from her formation, and from the diseases of her womb. 

The first impediment I shall mention to births, on the part of 
the mother, is the bad formation of the pelvis, a most rare occur- 



214 

ranee, indeed, in all countries like the United States, where chil- 
dren are brought up without that confinement, which destroys 
their vigour and make. The chief defect in the formation of the 
pelvis, is the projection of the back bone too far forward, that is, 
near the front, or pubes. The extent is ascertained by introduc- 
ing the finger near the pubes, and moving it back to the most 
projecting part of the back-bone; care being taken not to move it 
downwards, in the hollow of the sacrum. By this mode, it may 
be ascertained if the opening be three inches wide: such are the 
powers of the mother, that often through a lesser opening, of two 
and a half inches, children are born. When the presentment of 
the child is natural, in cases where the pelvis is found small, the 
rule is to let the labour progress, as long as the powers of the 
mother exist in good state: but if no progress be made in the la- 
bour, that is, if the child do not descend at all in the pelvis, if 
the labour have continued, so that the mother's strength is great- 
ly impaired; lastly, if, after consultation with the best profession- 
al advisers, it be determined impossible to deliver the child liv- 
ing, the only object is the safety of the mother: the child is to 
be brought away by pieces. 

The instrument for doing this, is called the crotchet or perfo* 
rating scissors. Dr. Bard's account of using them, is annexed, 
as a subject of reference. 

After serious consultation, the operation being determined on r 
the woman is to be placed on her back; the fingers of the left 
hand being introduced into the birth-place, and fixed on the pre- 
senting part of the child's head, (be sure the mouth of the womb 
is sufficiently opened,) the scissors made for the purpose, are then 
pushed through the palm of the hand, and between the fingers, 
and piercing the scalp to the skull, the bones are perforated by a 
boring motion, until the fingers reach the stops on their edge; (a 
much better plan is, when the sutures, or a fontanelle can be felt, 
to introduce the scissors through them, and destroy the organi- 
zation of the brain;) the scissors are, when introduced, to be open- 
ed in one direction; turning them half round, (the joints guarded 
by the fingers of the left hand,) they are to be closed, and opened 
again in the opposite direction; and again turned round, so as to 
destroy the texture of the brain; then being closed with the same 
care not to entangle any of the soft parts of the mother, they may 



215 

be withdrawn. Some time is now to be allowed for the woman 
to rest: and for the pains, if they still continue, to produce their 
effect, in discharging the brain, and lessening the diameter of the 
head. 

This being effected, we next endeavour to remove any rugged 
edges of bone which might injure the mother; and then passing 
one or two fingers within the skull, and taking hold at the edges 
of the perforation, we may endeavour, in that way, to assist the 
pains in forwarding the birth. But in a necessary and justifiable 
case, we shall be able to make but little progress in this way; and 
we shall find it necessary again to fix the fingers of the left hand 
Over the opening in the skull, and between them to introduce the 
crotchet within; then fixing the point on some of the bones, with 
the left hand so placed within the vagina, and the fingers so spread 
on the child's head, as that the point of the instrument, should it 
slip, will rather strike the palm or fingers, than the parts of the 
mother; we exert as much force, gradually increasing it in ex- 
tracting, as the parts will bear: and should they give way, the in- 
strument is to be fixed again on another part, or on the outside of 
the head, in the eye, under the jaw, or behind the ear; and vary- 
ing the direction of the extracting force, as far back as possible, 
from side to side, or directly forward, endeavour to bring the 
head through the contracted pelvis. If we again fail, both hooks 
may be fixed, one on each side of the head, by which as much 
force may be exerted, as can be necessary, or as the parts will 
bear: nor is it easy to conceive how much force, or how tedious 
and fatiguing an exertion is sometimes required. All, however, 
is to be done deliberately, slowly, and cautiously; resting our- 
selves, and allowing the patient to rest, and, from time to time, 
to receive some mild, cordial nourishment. Haste is seldom ne- 
cessary, and although we may wish the delivery accomplished as 
soon as possible, we must never be hurried. 

Having delivered the head, a cloth is to be wrapped round it, 
or a handkerchief round the neck; by which we may make use of 
as much force as we dare, without risking the separation of the 
neck from the trunk. And if even with this, we do not succeed 
to bring down the shoulders and breast, which in a very narrow 
pelvis, will sometimes be the case, we are again compelled to 
have recourse to the perforator, to fix it in the arm pits, or to tear 



216 

open the chest, or the abdomen, when swelled in consequence of 
putrefaction: which, in a child long dead, is frequently the case. 

This, as well as that in which the child's head may be enlarg- 
ed by disease, particularly the hydrocephalus, are cases in which 
the perforator may be required, even in a woman with a well- 
formed pelvis. The hydrocephalus may be suspected, when in 
the beginning of labour the child's head readily recedes from the 
touch, floating as it were back in the waters of the womb; or 
where, in a well-formed pelvis, the head remains a long time 
above the brim without engaging in it, notwithstanding active 
pains; and at the same time, we can discover the sutures and fon- 
tanelles very largely open, and the bones very easily moved on 
each other. Yet so much uncertainty always attends this conjec- 
ture, even in a person of considerable experience, that it becomes 
our duty to wait as long as the pains continue regular, and the 
woman's strength be not greatly impaired. 

It will generally happen, that the expediency of introducing the 
hand, and delivering the feet, with the hope of saving the child, 
will occur before we have recourse to the last remedy: this will 
put it in our power to examine carefully the nature of the case, 
and to ascertain what it is which obstructs the labour. If the 
head be not found very large, nor the pelvis very narrow, it may 
be proper to proceed, and deliver the feet; but if the head be 
found swelled very large, the chance of saving the child will be 
so little, and perforating the head, in this case, so easy and safe, 
that it may be most justifiable. The perforation in this case, 
is generally all that is necessary; as soon as the waters shall be 
discharged, the head will collapse y and the labour may then be 
left to nature. 

The death of the child, when that can be ascertained, removes 
every objection to the use of the crotchet, when otherwise neces- 
sary. But of this there is but one real evidence; that is the sepa- 
ration of the skin from those parts of the child which can be felt. 
Neither coldness of the abdomen, disappearing of the milk, ces- 
sation of motion for any length of time, nor even putrid and offen- 
sive discharges from the womb, are to be depended on. But the 
peeling off of the scarf-skin is unequivocal, and is sometimes at- 
tended with such a distension of the cavities from extricated air, 
as t© render it necessary to open them before the child can be 



»: 



217 

born; and for this purpose, the scissors and crotchet are the most 
convenient instruments. 

Another and more common cause of difficult and tedious la- 
bours with mothers, is found, not in the bones, but in the womb; 
it sometimes does not act; it acts irregularly; its mouth will not 
dilate; its mouth is also subject to displacement. 

The remote cause of these irregularities is most generally an 
inflammatory state of the system; marked by too violent action 
in the beginning of labour; sometimes by a prostration of the ani- 
mal powers. Relief is had by free bleeding, even when the i^uise 
is weak, if the person be of a strong, healthy make. In these ca- 
ses a physician should attend, to judge of the power of the pa- 
tient, and direct when delivery is to be forced. Constant atten- 
tion must be paid to emptying the bowels and bladder in all te- 
dious cases, more particularly than in others. 

One particular cause of tedious labour is, the refusal of the 
mouth of the womb to dilate; it remains rigid, as will appear 
from feeling it. The remedy most universally successful, is free 
bleeding, sometimes as much as forty ounces. A vomit has been 
often given with success. Filling up the birth-place with a large 
quantity of sweet oil, keeping the oil in by a plug of cork, sur- 
rounded by a rag, will be of great service. Sitting over the steam 
of hot water, is also beneficial. There is probably no case in 
which these remedies, properly applied, would not relieve.— 
These labours last sometimes very long; diet to be very low, 
and exercise taken freely, though not to fatigue. 

Another direct cause of tedious labour, is the refusal of the bo- 
dy of the womb to contract; the pains are irregular, but there is 
not an equal contraction of the womb; bleeding in these cases, is 
proper. Professor James, of Philadelphia, says, "from the repeat- 
ed trials of the effects of spurred rye, (called ergot) that, when 
the soft parts concerned in labour are dilated, in order to render 
the interior action more perfect, a dose of one scruple of this me- 
dicine, finely powdered, should be given, suspended in a little mo- 
■P lasses and water; that the dose may be repeated in half an hour 
if the interior contractions are not energetic; that he never found 
occasion to give a third dose." This is a most important disco- 
very; the medicine ought to be in every midwife's hands. I sup- 
pose it will nearly supersede the use of the forceps, for hurrying 
B b 



218 

the birth. Nevertheless, as cases may occur in which it may not 
be safe to trust to this medicine, I extract the following account 
of the manner of using- them: 

The forceps are made of two blades, corresponding to two le- 
vers, of shape and make as may be seen by reference to them in 
physicians' hands. The one part separates from the other; and 
this one part, called a lever, in most cases, answers as well for 
hurrying the delivery, as the two united, called the forceps. The 
manner of using each is as follows, after giving a clyster, and be- 
ing certain that there is no urine in the bladder, by introducing 
the catheter. 

The best position for the woman to lie, is on her left side, the 
posteriors near the edge of the bed. The operator is to intro- 
duce the fore finger of the right hand to the child's ear; then 
holding the blade or lever in his left hand, he is, under his finger^ 
which is his guide, to push it slowly over the ear, till the claw of 
the blade is at the edge of the birth-place. The introduction of 
the blade will probably renew the pains, of which advantage is to 
be taken, by using the blade during the pains, and desisting dur- 
ing their intermission. The manner of acting is to hold the left 
hand on the blade, close to the birth-place, and with the right 
hand to raise the handle of the instrument slowly, but firmly; so 
that while the part held down with the left hand, keeps it fixed, 
the other end presses the child's head downwards, in the hollow 
of the sacrum, and thereby ends in the expulsion; when there are 
no pains, we are to imitate them, by acting and resting alternate- 
ly. The head soon begins to descend, and distend the perineum, 
which is to be supported by an assistant. 

When, instead of this blade or lever, the forceps are to be used, 
after the introduction of the first blade above, the second is to be 
introduced with equal care below, precisely opposite to the first. 
Should the opposite ear not be felt, the direction of the blade must 
be by the position of the first. Both blades being most slowly 
introduced, the claws are to be brought together and locked, care 
being taken not to entangle any of the hair, or soft parts, in the 
lock. If, on endeavouring to lock the forceps, the handles do not 
come near together, or are very far apart, or are close together, 
the points of the blades are not properly fixed; the last one should 
be extracted, and more carefully fixed. 



219 

The forceps being so fixed as to enclose the head of the child, 
the handles being held in both hands, they are to be moved from 
handle to handle, or upwards and downwards, or from ear to ear; 
because, if moved from side to side, .or face to crown, they will 
slip off. The most gentle force only is to be used. Dr. Meri- 
man observes: " when acting with the forceps, the force at first 
used should be very moderate, but is to be increased as occasion 
may require;" yet if the head advances at all, however slowly, 
with the force first applied, it need not be increased: for, as Dr. 
Denman truly remarked, " a small degree of force, continued for 
a long time, will be equal to a greater force hastily exerted; and 
with infinite less detriment either to mother or child." 

In concluding this short sketch of the use of instruments, so 
terrible to many ladies in imagination, I would remind you of 
the folly of such fears. What are these mighty instruments? a 
pair of scissors, to cut as they open, dignified with the name of 
perforator, as harmless to the mother in this operation, as proper 
to be used, when the child cannot be born living, or is dead. — 
And what are the forceps? a pair of large pincers! one blade, 
when used alone, dignified with the name of lever. And as to 
their use, a source of no pain to mother or child, requiring not 
more sense for fixing them over the ears of the child, so as to 
compress its head equally, and not injure the mother, than the 
application of a pair of pincers to pull out some body from a 
mass which a little surrounds or envelops it. Taking this fair 
view of the subject, I think that although not one in half a mil- 
lion may have to submit to the operation, all ought to view it as 
a simple affair, without terror. 

I now come to the third cause of tedious labours. It is when 
the mouth of the womb is turned towards one side of the woman; 
or thrown backwards to the back of the pelvis, so as nearly to 
reach the sacrum or back-bone; or thrown forwards over the 
pubes; but it is very questionable if the latter ever occurs. 

Laying on the opposite side will change the leaning of the 
mouth of the womb; but when the mouth is turned backwards, 
(which occurs sometimes with those of very pendulous bellies,) it 
is recommended to lay on the back, the hips elevated; and it may 
prove of service to support, or push towards the back bone or 



Spine, the top of the womb, it being* the part nearest the stomach. 
The fact of this inclining backwards of the mouth of the womb, 
will be ascertained by introducing the finger up the birth-place, 
artd finding the mouth of .the womb not in its proper place, but 
pushed backwards, scarcely in reach of the finger. In these cases, 
the head enters the pelvis, the parts nearest the pubes being co- 
vered with the front of the womb, which has been mistaken for 
the child's head, without hair. The delivery requires patience, 
and no interference. 

PRESENTATION OF AFTER-BIRTH AND CONVULSIONS. 

Before concluding the subject of delivery, I will remark two 
cases of rare occurrence, and attended with great danger. The 
first is, when the after-birth adheres to the mouth of the womb; 
aud at its dilatation, bleeds freely. By the introduction of the fin- 
ger, the orifice of the womb will be felt dilating during a pain.— 
The practice recommended in these cases, is to introduce the 
hand, gradually dilating the parts, to push it through the body of 
the after-birth, feel for the feet of the child, and deliver with as 
much rapidity as in footling cases, without bursting the parts of 
the mother. Although I never had such a case, I would strongly 
recommend in preference, two doses of the ergot, the one half an 
hour after the other; at the same time squirting up the birth- 
place a strong solution of sugar of lead, the buttocks elevated, a 
tight plug in the birth-place, then to cover the external parts with 
the hand, firmly pressing, to prevent the escape of blood, until the 
head of the child advances. So long as the womb contracts, no 
blood can flow, if you will prevent its passage externally, which 
I am sure, by hands to relieve each other, may be clone till the 
ergot operates. When there are no pains, then turning, and de- 
livery by the feet,, is the only resource: using all means to irritate 
the womb to contraction, which have been mentioned in the sub- 
ject of the after-birth. 

The second case is attended with convulsions. These often 
arise from irritating matter in the bowels. The remedy is bleed- 
ing freely:, at the same time, pour down the throat either twelve 
or fifteen grains of calomel, or any other purgative medicine. In 



addition, a solution of a spoonful of salts ought to be given; also 
a clyster every two hours, until the purging is free. When the 
stools are offensive, their irritating nature will be greatly lessen, 
ed by giving the patient one or two tea spoonfuls of chalk, or 
half as much salt of tartar, or, what is nearly the same, a table 
spoonful of common ley and charcoal, every two hours, either 
mixed in milk or water. When the head of the child is low in 
the pelvis, it is advised to hurry the delivery with the forceps. — 
A scruple of the ergot, given and repeated in half an hour, ought 
first to be tried. At all events, the woman is to be speedily de- 
livered, or in all human probability she will expire. I would not 
hesitate to introduce the hand, and with the finger rupture the 
waters; when, if the birth did not come on, I would turn the 
child, and deliver by the feet. The neglect of this, I well remem- 
ber, was the cause of the death of a very good lady, Mrs. C , 

of Washington; while, at the very same time, Doctor Warfield, 
of Georgetown, relieved a woman in a similar state of convul- 
sions, by forcing delivery. 

OF LESSENING THE PAINS OF LABOUR. 

The first point I wish to impress on your minds, is, that labour 
being an operation in which the whole system is greatly concern- 
ed, the main object is to preserve the general health. I have al- 
ready told you, that washing and rubbing the skin, especially in 
parts where there is great secretion; that a plain, simple diet, 
regularly taken, with exercise in open air, are indispensable re- 
quisites for health. You are already apprised, that the confined 
contents of the bowels generate such stimulating, offensive air, 
as to distend, and excite to diseased action the womb and neigh- 
bouring parts; all effectually prevented by daily evacuating the 
bowels at the same hour. I state it as an incontrovertible truth, 
that universally the woman who preserves her health by diet, ex- 
ercise, and cleanliness, instead of by physic, will have infinitely 
the best time in child-bed. 

It has been urged, that a free use of sweet oil in diet, tends to 
lessen the pains of labour. I have seen cases where many be- 
lieved it to have this effect. Its free use in bathing the belly, 
and in injecting it, and retaining it up the birth-place, as labour 



advances, certainly tends to lessen considerably the painful irri- 
tation and distension of the exterior parts. 

But of greater efficacy, of greater certainty, I recommend the 
loss of blood, when labour commences. It has been recommend- 
ed by the ablest physicians in this country. I have never seen a 
person who resorted to it, that failed having an obvious mitiga- 
tion of suffering. Abundant diet, the high action of the system 
converting the fat into blood, give sufficient reason for its univer- 
sal use, excepting in those enfeebled by disease. In addition to 
lessening the pains of labour, it lessens the diseases apt to follow. 
It is impossible to give you directions applicable to each case; 
but I would recommend to all who are ten hours in labour, to 
lose from ten to twenty-five ounces of blood, according to the vi- 
gour of the system, unless reduced by disease, as before remark- 
ed. There is nothing which will so lessen the painful contrac- 
tions of the womb, and increase the dilatation of the exterior 
parts; or so effectually prevent their inflammation, and the sub- 
sequent diseases of the constitution, which destroy so many. 

After the evacuations are made, as far as they can be borne, 
sometimes a good dose of laudanum, to allay irritation, has been 
advantageously given: but it should never be taken when the sys- 
tem is in an inflammatory state; and I would recommend that it 
should be only given from the advice of a physician, if one can be 
procured. 



ADDRESS IV. 



TO MOTHERS AND THEIR ATTENDANTS. 



Management of Women after Labour: Diseases ensu- 
ing: and Diseases of Children. 

Most of your sex indulge in great apprehensions of the dan- 
gers of bringing forth; they seldom fear the hazards of the suc- 
ceeding month: but I will venture to assert, that five women 
have died from mismanagement after delivery, for one at deli- 
very. It is an established fact, that our systems very well en- 
dure the excesses of any one state continued: in any wet, dry, 
cold, or hot climate, our bodies will be in perfection; but the 
moment changes are made, the animal powers are affected and 
diseased. The delivery of the great mass contained in the 
womb, which for nine months it had so highly stimulated, is a 
change producing as great a revolution in your systems, as any 
to which your bodies are exposed It is at this revolution, that 
diseases enter, overpower, or undermine your constitution; and 
that the exertion of the greatest sense is demanded for your 
preservation. 

You have been told that your systems, during pregnancy, 
were in an inflammatory state, marked by quickened pulse, and 
the buff coat appearing in your blood when drawn. The eva- 
cuations at delivery, lessen, but do not entirely relieve it. A 
fever of considerable action follows; an over secretion of milk 
marks the excitement, necessarily increased by stimulants and 
confined air. 



224 

With such facts, would you believe, if you had not heard, 
and probably often seen, that it is customary to dose women re- 
peatedly after delivery with spirits, wine, and spices; their heat 
and exhalations retained, still more stimulating their bodies; and 
the contamination of the air they breathe, increased by dirty 
clothes, bed curtains and closed doors? 

I have already suggested to you the selection of the largest 
room in your houses for delivery. I would press that from the 
beginning to the end, the door should be kept a little open. 
The current of air should be kept off with a screen, not by bed 
curtains. Every thing filthy should instantly be removed from 
the room: old carpets amongthe number, unless effectually wash- 
ed. The cleanest as well as largest apartment of a house, should 
be that used for lying-in. Frequent cleansing, and a free admis- 
sion of fresh air, are to be had, without exposure to cold. True 
that nothing is more destructive to women than receiving colds 
after child-delivery; but those are ten times more subject to 
them, who are confined to a close air, than those who are not. I 
am sure, by the exercise of your own sense, you will always find 
means to keep your bodies comfortable, neither oppressed with 
clothing, or so exposed as to receive. colds. 

The treatment every woman requires after child-bearing, is 
almost precisely that directed for the small pox. By follow- 
ing that course, you will find benefit equal to that which was 
,ibuiid on substituting a cooling diet and air, for the heating, 
stimulating practice pursued formerly, with those who had the 
small pox. 

After a woman is wiped dry, and rolled over, or lifted up, to 
the other side of her bed, she should, if not disagreeable, lie on 
her back, with a pillow on her belly, which will produce a mo- 
derate compression on the parts. The more perfect her rest, 
the better: there should be as little moving as possible. The 
child should always be applied to the breast before ten hours 
elapse, after washing the nipple in warm water, to take off the 
bitter matter adhering. Those who have had much loss of 
blood at the delivery, will probably be long in having the milky 
action in their breasts. To such, as to all doubtful of having 
milk in time, I would strongly recommend the application, for 



225 

an hour or two, of a large, soft, warm poultice of bread and 
milk, around and over the nipple, which will foment the parts, 
and promote the secretion of milk, with less febrile exertion of 
the system. 

At the beginning of the second day after delivery, every wo- 
man should have a flannel roller, or some kind of compression, 
applied around her belly. This is not designed to make her 
sides grow together! therefore it is to be moderately close, ra- 
ther loose. It should be continued during her month's confine- 
ment, so that the sides of the belly being kept from distension, 
her belly will not be so apt to protrude or distend, after the re- 
covery. A tight, instead of a simple supporting bandage, is 
injurious. On the second day, a dose of castor oil, or magne- 
sia, or salts, ought always to be taken, if the bowels have not 
been opened since delivery. An injection of warm soap and 
water will answer. You have no idea of the degrees of disease 
brought on by neglecting to do this. The bowels have been 
in an unusual state, and their diseased action is readily excit- 
ed, by the confined contents. Many of the women who have 
died, while lying in, have perished from neglecting to evacu- 
ate their bowels. Indeed, I know the importance of it so well, 
and feel such anxiety for your escape from disease, that I most 
earnestly entreat you, for your own and your child's sake, never 
to let more than twenty-four hours elapse from the hour of de- 
livery, until your perfect recovery, without having an evacua-*- 
tion from your bowels, naturally if you can, but if not, by the 
artificial means of introducing a piece of soap in the fundament, 
or of an injection, or a laxative medicine. The proper place 
to have this evacuation is in bed. lying over a bed pan, which 
ought to be in every house. 

The next thing I wish most earnestly to recommend, is, to 
wash the birth-place every day in warm soap and water after 
delivery, for at least one week. It may be done under the bed 
clothes, the bottom a little elevated. A basin pushed under the 
breech is all the preparation necessary. Women in confine- 
ment ought to have a syringe for injecting in the bowels, and 
the same will answer to squirt warm water up the birth-place. 
The utility of taking away the irritating secretions from the 
C c 



parts after delivery, (called lochise,) is indeed truly great. The 
retention, inflaming- the womb and bowels, has been a great 
cause of the fevers of lying-in women. This discharge gene- 
rally lessens on the third day, when the breasts distend with 
milk; it varies considerably in smell, colour, and quantity, 
These changes in smell and colour arise chiefly from the vary- 
ing putrefaction or fermentation it undergoes after it is secreted 
by the vessels of the womb. I mention this, to induce you to 
be the more particular in its removal. The quantity of the 
discharge differs in almost every woman. It indicates the de- 
gree of increased action in the womb; and although it is a sub- 
ject of very general anxiety, it is not very material whether the 
quantity be great or small; provided no other disease exist, nor 
fevers nor too much weakness be apprehended. Whenever it 
is of a very offensive nature, by all means inject, with consi- 
derable force, warm soap and water up the birth-place: it will 
assist in the expulsion of the clots of blood that may be de- 
tained and in other respects will be of great service to the sys- 
tem. A common squirt, made of elder, will answer the pur- 
pose; and I beseech you to inject soap and water freely, if 
not daily, at least on the slightest appearance of disease. The 
linen should be changed every day during confinement; and dry 
cloths pushed underneath the breech, which can be done by a 
good nurse, without disturbing the patient. 

Unless prevented by good reasons, every woman should be 
raised a little in her bed, the day after delivery, for half an hour 
or an hour; she may be supported with a chair and pillow at 
her back. A little sitting up promotes the natural evacuations 
from the birth-place, and should be prolonged every day, — not 
enough, however, to fatigue, sometimes this is attended with 
fainting feeling, but it in general speedily goes off. The wo- 
man should not stand up before the fifth or sixth day; and not 
leave her room before the eighth or tenth, and then but at short 
intervals. In making these changes, a middle course is to be 
observed; they are to be effected gradually — never exposing to- 
a current of air, or oppressing with too much warmth or 
clothing. 



\ 



Dr. Moss, the judicious writer before quoted, says, the treat- 
ment of lying-in women has been, till very lately, universally 
founded upon the supposition that, from the moment of delive- 
ry, and for a certain time after, they could not have too frequent 
and plentiful supplies of warm liquids, cordials, and nourish- 
ing food, in the form of gruel, of different sorts, made with spa- 
ces, with the addition of wine or spirits: and that an unusual 
degree of warmth and sweating were to be kept up by these 
means, further supported by the warmth and closeness of the 
room, confinement to bed, and an additional quantity of bed 
clothes. All this was done with a view to support and recruit 
the strength and spirits, and to keep off cold and its effects. 
However, these opinions and practices are proved by experi- 
ence, not only erroneous, but, to produce the very evils they 
were intended to lessen and obviate. 

There is, from the time of delivery, a constant, particular, 
and natural propensity and disposition to fever, which gradu^ 
ally increases the first three or four days, and is a source of 
great danger. Whatever will add to the heat of the body, or 
action of the system, will increase and prolong this fever; than 
which, nothing is more calculated than wine, spices, cordials, 
and liquids of all kinds taken hot, with unusual warmth in the 
room and bed. A person in the highest health, so treated, 
would most likely have a fever: and it is easy to conceive how 
much the milk fever of women, and all its consequences, are to 
be aggravated by such treatment. 

A coldness and shiverings very commonly accompany all fe- 
verish complaints, and of course very common at this time;' 
which may have led to the notion of the warmth, and warm 
things being proper, by way of preventing them, and removing 
them when present. But this is a false and mistaken opinion ; 
for whatever brings on the fever, may be said to bring on the 
shiverings also, as the shiverings will not come on if the fever 
be kept off; and when the shiverings are actually present, the 
most heating things will not lessen or abate them, so as to do 
good: therefore no more than a moderate warmth should ever 
be employed for that purpose. 



228 

The sweating which is brought on by this warm treatment, 
has also been supposed necessary to prevent or carry off any 
degree of the fever, and to prevent the shiverings; but which 
is a notion as fallacious as the other, as it not only serves, 
when in excess, or long continued, to support and increase the 
fever, but exhausts the strength and spirits. 

Those who lie-in, are sensible how liable they are to be over- 
heated by the most trifling additional heat of the room or bed, 
or by taking any thing warm, which makes them feel very un- 
comfortable and uneasy to themselves; often have the head- 
ache, perceive a faintness, weariness, and depression of spirits; 
all which continue, and are increased, according as the heat 
and heating things are repeated; and are the symptoms of the 
feverish complaint mentioned. On the contrary, they who are 
never exposed to be over-heated by the warmth of the bed, the 
room, or what they take, seldom or never experience these dis- 
agreeable sensations, but feel comfortable and easy to them- 
selves, and find their strength and spirits increase apace; all 
which desirable circumstances, with many others, are entirely 
effected by subduing and keeping off this feverishness, by cool 
treatment. 

You will, ladies, be well paid for imposing on yourselves 
jthese restraints after delivery. Give no attention to the stories 
of perfect recovery under a different treatment. I beseech you 
to bear in mind, that it is not so much on account of present 
exemption from disease, as to save your constitutions, which 
at some future day will suffer for your transgressions. After 
this operation of delivery, your systems are in their most deli- 
cate state; from the most inconsiderable causes', sensibly or in- 
sensibly, they become, or will become, most seriously affected. 
To conduct you with safety through these changes, far more 
skill is requisite than for the delivery of your offspring. In- 
deed, for the latter, wise nature is the actor; for the other, man- 
agement; the directions of our confined minds are to come in- 
to operationl Do not understand me as saying that you must 
consider yourselves as patients, requiring doses from doctors: 
you only require the hourly exercise of common sense. Be 
quiet in mind and body: most gradually let your systems be 



229 

restored to their common state and action, by returning to your 
habitual diet and exercise in slow degrees; subdue all inflam- 
mation on its first approach, by abstinence, and by evacua- 
tions. These are the suggestions, not so much of medical 
knowledge, as of common sense. Observe them; and if in 
other respects you do not act in opposition to the dictates of 
this common sense, you will pass through child-birth with a 
safety greatly superior to that of the generality of your sex 
heretofore. 

DIET AFTER DELIVERY. 

The first remark I have to make, on this subject, is, that the 
intended kindness of women to each other in child-bed, has de- 
stroyed more than it has saved. The diet of our penitentiaries, 
bread and water, would prove a blessing, from the highest 
to the lowest of your sex, if it were strictly adhered to for 
the first two weeks after delivery. I could scarcely name a 
disease which has not been brought on, either directly or indi- 
rectly, by the cramming of strong stimulating food during 
confinement. 

It is not my intention to recommend almost starvation, as 
has been done so extravagantly by some writers: but moderate 
diet. I would advise every woman to eat small quantities of 
food; bread, potatoes, rice, barley, or any common vegetable; 
nothing heating — no spices; from the beginning, eating pre- 
cisely at the same hours that meals are taken in health. Keep- 
ing up the habitual action of the stomach, has a powerful effect 
in keeping off diseased action. The first day, the quantity 
should not be much; but after the second day, the bulk taken 
may be nearly as great as the person was in the habit of taking. 

Not till the first week passes, would I consent that meats, 
butter, and very nourishing articles, as cream custards, Sec. 
should be taken. Nor would I agree to a return to a free 
use of meat during the first month. The drink at this time> 
should be water, weak tea, or gruel; towards the last, very mild 
soup. A gruel made of oat-meal, is greatly esteemed by many 
ladies. 



230 



OF DIET. AND GIVING MILK. 



I have now to urge the necessity of all mothers suckling 
their own children, if they desire to preserve their health. It 
is to me a subject of astonishment, how any woman could be 
so lost to the feelings .of nature, as to give up the pleasure of 
this undertaking. As they are not alive to the joy of furnish- 
ing the food from their own bodies for their babes, they ought 
to be solemnly warned of the effects on their own constitutions, 
by such neglect. Such is the wonderful nature of the system, 
that no one function can be suspended, without its having some 
influence on other parts of the body. Unless every part goes 
through its natural action, or irritation, some other part of the 
body will, even at most distant days, take on an action of dis- 
ease, equal in extent, and more fatal in consequences. The 
womb, I believe*, never properly performs its office, when not 
relieved by the determinations to the breasts. Nor is this the 
only evil; for a little while you may escape disease, but at last 
you will suffer greatly for not conforming to nature in suckling 
your children. Cancerous womb and breasts, diseases of the 
bones, rheumatic and other pains, will come on, as symptomatic 
of the action which would have attended the milky secretion. 
For ever bear it on your minds, that nature will not be trifled 
with; her laws are not to be violated with impunity; atonement 
she will have for all your irregularities. Your physician may 
postpone, but your bodies must make the payment at last, as I 
have before remarked. 

It is a subject of considerable anxiety among mothers, what 
is the best food for them to take while giving suck. I am 
happy in being able to settle this question with perfect cer- 
tainty ; and I beseech you to remember it. 

I have already stated, that the stomach secretes v. u oi'iid to. 
dissolve what we eat, which becomes adapted to the nature of 
the food we take; a change in diet always changes this liquid, 
and the stomach can never be changed, without its affecting 
other parts of the system. The diet then for a woman, is the 
diet to which she has been most accustomed. If she has not 



231 

been habituated to any one, she should commence while giving 
milk, for at least the first three months, until the powers of the 
babe become equal to the change. The diet should not be so 
thin as is generally taken; it causes the milk to be too watery; 
requiring such large quantities for the child, as to derange its 
stomach, and incline to gluttony. This effect is pretty much 
as the secretion of urine on drinking freely of liquids; it con- 
tains not an eighth of the salts and other matter, which it has 
when secreted without such drink. The liquid does not go to 
the glands, but the glands sympathise with the watery excite- 
ment or state of the stomach, and secrete the watery fluid. The 
proper diet then for mothers, is one of solids — only a moderate 
quantity of liquids; never changed for the first three months; 
always, when to be changed, slowly done. 

It is very improper for women to take large quantities of sti- 
mulating drink while giving suck. There will be an abundant 
secretion from the stimulus of exercise; and this is the best sti- 
mulus. It is because women giving milk are so sedentary 
while suckling, that there are such determinations to the 
breasts, which end in so many disorders of the parts. They 
should take more exercise, by walking, at this time, than at 
any other, in order to equalize the action & the blood vessels. 
Among the delicate I would recommend the stimulus of any 
pure white wine, or porter, with moderate dilution. 

Some women give but small quantities of milk; in general, 
the difference in quantity is made up in quality. The means 
of increasing this secretion, are free living, great exercise, 
much handling, and drawing the breasts after the child has suck- 
ed. They should be drawn with a strong mouth, fully exerted, 
particularly when the action of the pulse is increased by full 
diet or drink. And there can be no doubt of success, especi- 
ally if a '^ c e hot poultice be immediately applied for two or 
three' 'jurs. 

When it is designed to suppress the secretion of milk, a di- 
rectly different course should be pursued. Abstemious diet, 
avoiding salt, taking but few drinks, and a daily purge are call- 
ed for. The whole breasts should be covered with a rag, wet 



28S 

* 

with a weak, cool solution of sugar of lead, to be applied every* 
two or three hours. Sweet oil may be substituted at night.—- 
When they become painfully distended with milk, they should 
always be slightly drawn, merely enough to relieve the dis- 
tention. 



DISEASES OF LYING-IN WOMEN 



FAINTINGS. 

The first complaint after confinement, is generally a sense of 
faintiness. As soon as observed, an examination should be 
made, to ascertain if there be flooding. In this case, cold ap- 
plications, and cool air, are indispensable, and should be freely 
used; the head kept low, and the womb compressed with the 
hand, to make it contract. When there is no loss of blood, a 
glass of wine or toddy should be given with gruel. A wide 
bandage around the belly, drawn tolerably tight for an hour or 
two only, will support and compress the parts, and thereby re- 
lieve the complaint* Sometimes this arises from the falling 
down of the womb; which points out the propriety of feeling for 
the womb, in the belly. When there is great coldness of ex- 
tremities, hot applications should be made to them. 

CHILLS. 

When the chills and coldness which women generally have 
after delivery, are excessive, they are tc> be relieved by hot 
bricks to the feet, wrapping the legs up in hot flannels, and hot 
applications to the belly, opposite the stomach. Their legs 
may be rubbed under the bed clothes, with a coarse brush. But 
it is absolutely improper to take stimulating drinks, as they ac- 
tually increase the fever which ensues. Hot tea or gruel is the 
only drink that ought to be taken. When the shivering is ve- 
ry violent, it is expedient to hold the patient's limbs fixed, or 
grasped in the hands of assistants, until it subsides. 



238 



AFTER PAINS, 



These pains are generally least distressing at the delivery of 
the first child, and after long, tedious labours. They arise from 
the contractions of the womb, to expel clots of blood, and the 
secretion contained in it. Sometimes the pains are almost as 
severe as those of labour. They are felt in the lower part of 
the belly, and sometimes in the back, like those of labour. 
They are usually accompained with the discharge of clots of 
blood, and frequently are renewed for a day or two, especially 
when the child is applied to the breast. 

When these pains are moderate, they should not be interfer- 
ed with. When they are severe, they will be relieved by a 
bladder of hot water on the belly, or hot, wet cloths. An injec- 
tion of forty or fifty drops of laudanum in the bowels, will ge- 
nerally afford relief: as also half the quantity swallowed. But 
this had better be dispensed with, as all stimulants are apt to 
do injury; especially the spices, drams, and wines, usually giv- 
en by old women to relieve this complaint. 



IRREGULARITIES OF THE LOCHIJE. 

As before remarked, the discharge following delivery is call- 
ed lochias. Its continuance is for several days, and gradually 
subsides; changing in colour very frequently. When it is very 
offensive, powdered charcoal should be introduced, after wash- 
ing with soap and water. When it is very profuse, endanger- 
ing the great weakening of the patient, it will be proper to ap- 
ply occasionally cloths, clipped in cold water, to the belly; to 
inject a little cold water into the bowels, as well as birth-place; 
and to give a moderate laxative, to cleanse the bowels. But 
when the discharge suddenly stops, a very different treatment 
is necessary: blood-letting may be called for; certainly a purge 
should be given, and warm applications made to the belly; and 
injections of warm water. 

Dd 



331 



LOCAL INFLAMMATIONS OF THE PARTS. 

When there is great soreness about the belly, acute sensibili- 
ty to the touch, it is. incumbent on every woman to evacuate 
herself freely immediately, and to foment the belly by flannels 
from hot water and sweet oil, until she can get a physician. — 
It is the badliabit of neglecting this course, which causes so 
many women to have the puerperal fever. 

Inflammations and sometimes suppuration of the external 
parts of generation, are extremely apt to occur after tedious 
labours. From slight ruptures or lacerations, sometimes con- 
siderable quantities of blood become effused in the substance 
of the lips of the birth-place, presenting a very alarming ap- 
pearance. But there is no danger; the blood being speedily 
absorbed or discharged. The application of cold water, or a 
solution of sugar of lead, or of sweet oil, or cold poultices, will 
speedily relieve the parts; or, if they are kept clean and cool, 
they will relieve themselves. Whenever the sides of the birth- 
place ulcerate, greased lint or rags should be daily applied, 
and stuffed between them, so as to keep their edges apart. — 
Women are also very subject to a bearing down of the womb, 
termed its falling- down, when describing the diseases of the 
womb. To remain lying quietly, repeatedly in the day wash- 
ing the parts, squirting water up the birth-place, fomenting 
with wet cloths when painful, taking nothing to stimulate the 
system, are the prescriptions to be attended to. Affections of 
the stomach, head, and bowels, often attend this complaint, 
and are mistaken for original affections, instead of those from 
sympathy. Doctor Burns says, although rash management on 
the part of the midwife may occasion this complaint, yet it is 
much oftener the fault of the patient herself: getting up too 
early after delivery or miscarriage. There is another affection 
which may be mistaken for this: it is a relaxation and protru- 
sion of the passage to the womb; forming a soft swelling at 
the sidej sometimes entirely encircling the opening; at others, 
greatest at one side; it gives no particular uneasiness, and dis- 
appears on going to bed. The cure is effected by washing it 



£33 

with weak solutions of sugar of lead, of white vitriol, or of 
alum. The frequent application of cold water alone, often 
cures. 

The parts about the fundament are very apt to become irri- 
tated, constituting lesser degrees .of the piles. The moment 
pain is felt in these parts, rags, wet with a weak solution of 
sugar of lead, should be applied; a rag wet with cold water, 
will often relieve. When the irritation is considerable, sweet 
oil, or fresh hog's lard, on going to sleep, will be of service: 
you should refer to the subject of the piles. Rarely the irrita- 
tion about the fundament arises from small worms in the low- 
er gut; when injections of brine, of sugar and water, or of any 
irritating liquid, will destroy them. 

INFLAMMATION OF THE BREAST. 

The inflammation of the breasts is a source of incalculable 
misery to mothers, and deprivation to children. All mothers 
should have such affections in their view at every confinement, 
in order effectually to guard against them. No complaint can 
be more certainly prevented by proper care. 

Again I tell you to bear in mind, that your systems are in an 
inflammatory state after delivery, for two or three weeks. It is 
the general fever which produces local obstructions. The 
means of prevention are: three hours after delivery, apply a 
soft, warm poultice of milk to the nipple and breasts, to favour 
the discharge of the first milk. Let the poultice remain from 
two to four hours; and, if the child do not suck, let some per- 
son suck a little milk from the breast. Let the breast be 
bathed with sweet oil, if possible to be had; if not, goose 
grease, or hog's lard. Never let the diet be free, until the se- 
cretion of milk be well established; and never let the breasts 
remain painfully distended with milk: for, in every stage of giv- 
ing milk, when the breast is full, from the slightest cold and 
fever, inflammation is apt to ensue. 

The most important means of lessening the liability of the 
breasts to inflammation, is never to have them too thickly co- 
vered; never fail to wash them every morning in cold water, as 



286 

regularly as the face. I dwelt sufficiently on the influence of 
cold water on important parts, while advising the daily sitting 
in a tub of cold water. The whole is applicable to the breasts: 
most animals have their teats exposed to cool air, and they, as 
the negroes, have but few afflictions of them. Begin with wip- 
ing them with a wet cloth; then lean over a basin filled with 
water, and let one at a time be dipped. Indeed, you will find 
this one of the most effectual means of preventing the inflam- 
mation of the nipple, as well as the breast. It will give a tone, 
a hardening- to the parts, which, exclusive of the cleanliness of 
the habit, will be extremely advantageous. You find your 
hands and face improved by this cold washing, and why would 
you withhold it from your breasts? 

The moment there is the least appearance of inflammation, 
apply a solution of sugar of lead, (a tea spoonful of lead to a 
pint of water.) Keep a rag wet with this constantly on and 
around it, until the inflammation disappears. If the inflam- 
mation increases, by all means apply leeches to the part, take 
a strong purge, and refrain from taking more than half of your 
ordinary diet, until the cure be complete. I have seen such 
excess of agony from neglecting these precautions, that I wish 
I could enforce the observance, by every woman with an infant 
at her breast. I believe that no woman will have an abscess, 
(called bile,) on her breast, who will duly attend, from the be- 
ginning, to what I have urged. 

If, by these means, the inflammation be not dispersed, its 
extent will be greatly reduced; and this is an important point, 
A blister to cover the part has been strongly recommended by 
Dr. Physic, of Philadelphia. I have repeatedly tried it with 
complete success, as most physicians have done. But if the 
patient will not submit, it is best to apply bread and milk poul- 
tice. When the matter is fully formed, it ought, at its lower 
depending part, to have a small puncture, for its gradual es- 
cape, without admitting air. As soon as evacuated, a little 
lard may be applied to the edges, then the solution of lead is 
to be continued, by covering with a wet rag as at first, in or- 
der to prevent a return. Rubbing the breast with the hand is 
often done, but it is injurious. 



237 

The question of drawing the nipples, when the breasts are 
in a state of inflammation, has been differently decided by phy- 
sicians, one in favour, the other opposed. The propriety, how* 
ever, of the prescription, depends on the treatment of the pa- 
tient. If it be determined, that the woman shall eat, and do 
every thing she can to increase the inflammation of the system, 
drawing the breast is improper, for it only brings on an addi- 
tional determination to the part, tending to increase the dis- 
ease. But if she refrain from inflaming her system, by exer- 
cise, diet, or drinks; if the breast be kept particularly cool, a 
rag wet with sugar of lead to the outside, (not on the nipple, 
where it may get on the child's mouth,) then moderately draw- 
ing the breasts once or twice in the day, is a most powerful 
remedy in relieving the inflammation, or congestion of blood in 
the breast. 

SORE NIPPLES* 

The frequency of the diseases of the nipple, unquestionably 
arises from the improper, manner in which they are treated. — 
Mothers expecting their daughters to become mothers, should 
pay particular attention to their manner of binding their 
breasts. Compression continued, will cause the entire absorp- 
tion even of our limbs: no wonder, then, that the tight banda- 
ges around the breast reduce its size, and destroy the nipple. 
No females but women have their teats compressed, or confin- 
ed. The more these are left loose, the less danger of sore nip- 
ples. The danger will be lessened by washing them daily in 
cold water. In those cases where the nipple has sunk, or been 
pressed in, wearing rings of wax over it, so that the nipple may 
protrude or pass through, or wearing the glasses called nipple 
glasses, during pregnancy, to promote the lengthening of the 
nipple, is proper. Washing them in brandy and water, has 
also been recommended for hardening them. 

When the nipple becomes sore, it is first necessary to guard 
it against the rubbing of the clothes, by wearing, during the 
day, a wax cup over it, made so as to receive the nipple. Those 
made of lead are better than of wax. Washing them with a 



238 

weak solution of sugar of lead in the beginning, is of great 
efficacy. Washing with a solution of alum in brandy, with 
spirits, borax in water, a solution of nut galls, laudanum and 
water, opium in water, port wine, and such articles, are to 
be tried occasionally, for a few days at a time. Dr. Bard says, 
"simply keeping a linen cloth constantly wet with rum, over the 
nipple, will frequently do more than either; but then it must be 
kept constantly wet. Somtimes precipitate ointment, on slips 
of rags, and applied, has done good.'* It has been found of ser- 
vice to procure the teat of a heifer. The way to prepare it, is 
to scoop out the inside; well steep it in cold water; then put it 
into spirits till an hour or two before using it: when it must be 
again laid in water, to take away the spirituous taste. — The 
teat is then to be wiped dry and sewn closely and firmly at the 
edge to the row of holes made in the ring or shield which is 
applied to the breast over the nipple. Great attention should 
be paid to washing it well after sucking. 

The best application to the sensible sores around the nipple, is 
lunar caustic. The caustic is to be applied to each little ulcera- 
tion, as is done for warts. Let the parts be tolerably dry, the 
end of the caustic merely moist, (not a drop pending to it,) and 
there will be but little pain; the cure is certain in almost every 
case. The milk can be drawn by the child, after covering the 
nipple with a rag As soon as the scabs come off, which 
will be in a day or two, the child may be applied to the breast. 
To preserve the parts clean and cool, and to be as little moved 
as fiossibky are important points in the cure. 

MILK FEVER. 

Between the second and third days after delivery, the breasts 
become distended, from the milk secreted in them, and the dis- 
charges from the womb diminish. This is attended with some 
heat, thirst, head-ache and fever. This fever is partly owing 
to the disturbance, which, to a certain degree, constantly takes 
place in the system, whenever anew process is established; and 
partly to the swelling and irritation of the breasts themselves. 
The degree of the action will be greatly lessened by following 



239 

the advice of early applying a soft poultice to the breast, to fa- 
vour the escape of the first secretion; then never failing to apply 
the child to the breast, within from six to twelve hours. Rub- 
|bing the breast with sweet oil, goose grease, or fresh hog's lard, 
will tend to prevent, as also taking some laxative, and confining 
to a low diet. 

When the fever takes place, the treatment is very simple.—- 
Give any warm drink, as lemonade, gruel, or weak tea; allow 
the free entrance of pure air; if the feet be cold in the begin- 
ning, apply hot flannels. During the whole fever, the above 
drinks may be taken. In general, no other prescriptions are 
requisite; but if the fever be high, the breasts painful, a purga- 
tive of salts should be given, a slight bleeding, then two grains 
of tartar emetic in half a pint of water, to be taken one-eighth 
every hour, till perspiration is excited. No heating articles 
to be used* When the fever is over, the recovery is rapid; to 
be promoted by sitting up, and taking the food before pre- 
scribed. 



PUERPERAL FEVER. 

The puerperal is commonly called the child-bed fever.— 
When it comes on, it is generally in the first week after delive- 
ry, about the third or fourth day. It begins with a shivering 
like the cold fit of an ague, and like it, is succeeded by great 
and burning heat of the whole body, thirst, flushing in the face, 
pains in the head and back, sickness at stomach, especially with 
great sensibility of the belly, so much sometimes, that the 
weight of the bed-clothes is oppressive; the belly feels full— 
sometimes there is great pain and a looseness. Sometimes the 
disease comes on without a shivering fit, beginning impercepti- 
bly with languor, faintness, sickness, frequent vomiting, sweat- 
ing, and looseness. It is distinguished from the milk fever, 
sometimes by the shivering, and by the breasts, which do not 
swell and become hard and painful as in the milk fever. 

This disease may be defined a general fever, partaking of the 
character of the prevailing fevers of the place where it appears, 



S40 

attended by inflammation of the womb, and the adjoining parts 
concerned during delivery. But in wards of hospitals, in con- 
fined rooms, in unhealthy spots, it often appears of a low, ner- 
vous character; and it is prevented by adhering to the directions 
given for the conduct of women while lying-in — most of all, by 
keeping the bowels open, the birth-place clean, and pure air. 

During the cold stage of the fever, hot applications are to be 
made to the feet. When the hot stage comes on, cool drinks 
are proper. The patient must be blooded and freely purged 
with calomel, followed by a dose of salts; a solution of tartar 
emetic, ten grains to a pint of water, and one or two spoonfuls 
taken every hour or two, so as to keep up a constant sickness 
of stomach, will afford the best means of relieving the fever.— 
Antimonial wine may be substituted, or any preparation of an- 
timony: but you may rely upon it, that keeping up the sickness 
just so long as the fever lasts, is the most certain method of 
cure; you should inject the antimony in large quantities into 
the bowels, if the stomach do not retain it. The belly is to be 
well covered with sweet oil; also, warm cloths, wrung out from 
hot water, are proper in allaying the irritation. As I never 
knew good sweet oil to be applied to or near an inflamed part, 
without lessening the irritation, I would not only have it ap- 
plied on the belly, but injected up the bowels and birth-place, 
and detained there as long as possible. 

When the action of the system is reduced, or when the dis- 
ease assumes the low nervous character, then an opposite 
course is proper: wine, bark, toddy, nourishing diet, are requi- 
site, in such portions as will keep up the action of the system. 
But I suppose you will be sure to have a physician to prescribe 
in these cases. 

MILIARY FEVER. 

Doctor Moss says, a miliary fever is what lying-in women 
are sometimes liable to; and is known and distinguished by an 
irruption resembling a rash, coming out commonly first upon 
the neck and breast, afterward upon the other parts of the 
body, and seldom or never upon the face; it generally appears 



241 

the thickest upon those parts which are kept the warmest and 
closest covered. 

The eruption, upon its first coming out, is red; but towards 
the second or third day, it becomes white, and soon after goes 
off with a dry scurf. The complaint does not, however, termi- 
nate here, as it is immediately succeeded by another rash or 
eruption, which proceeds, and goes off, in the same manner; 
and that, sometimes, successively and repeatedly. 

The time of its first appearing is uncertain: it seldom comes 
before the end of the first week; and may happen afterward at 
any other period of the confinement to the bed particularly. — 
It is attended with a sense of weakness, and a dejection and 
depression of spirits. 

This fever, and these appearances, are entirely occasioned by- 
much warmth, warm and heating things, and more especially 
by much and long continued sweating in bed, as there is every 
reason to suppose it never happens without, and except in con- 
sequence of much sweating. The means for preventing it, 
therefore, are very clear and obvious: and if the method and 
directions at, and from the time of delivery, and during lying- 
in, are properly attended to, it may always be with great cer- 
tainty prevented, and never be feared or apprehended. 

With respect to the treatment and cure of the miliary fever, 
when it does happen, it may be observed, in general terms, 
that the same means which will prevent it, are also the likeliest 
and best suited to remove and cure it. The medicines, and 
other medical treatment of it, cannot, with any prospect of ad- 
vantage, be here given; however, the following directions may, 
so far, be safely observed and attended to: Every means that 
can heat the patient, must be cautiously avoided. The room 
must be made cool, by removing the fire, or setting open the 
door, and even a window, if needful. The bed curtains must 
be undrawn, and the additional quantity of bedclothes, if any 
there be, be removed; all which must be done gradually. What- 
ever she takes as food or drink, must be cool, and without spi- 
ces, wine, or spirits of any kind. If she is costive, a stool or 
Vvvo, and not more, must be procured by a clyster, some laxa- 

Ee 



S4& 

live, infusion of senna, or castor oil: much of a looseness will 
be injurious. 

As soon as, by these means, the heat and sweating are check- 
ed and abated, she must be raised up and supported in bed, 
and, with the assistance of a bed-chair, she will be able to sit 
up in bed: and which she may do once, twice, or oftener in the 
day; observing that she be not too much covered up, and muffled 
in the bedclothes, &c, and that she has her hands and arms out 
of bed, which will be a means of putting an entire stop to the 
sweating, and, of course, of removing the disease. She ought, 
as soon as she is thought able of bearing the fatigue of it, to be 
got out of bed once a day, which will be an effectual means of 
removing any remains of the complaint, and also of preventing 
a return of it. The notion that is commonly entertained of the 
propriety of keeping up a heat and sweating, by way of forc- 
ing out the rash or eruption, is very erroneous, as the heat and 
sweating are the sole causes of the rash, and consequently the 
removal of them must be the most sure means of removing the 
complaint: and except the sweating is checked, and even en- 
tirely stopped, (which may be done with safety, by degrees,) 
all other attempts to remove the disorder will be vain and fruit- 
less. It is well known that long continued sweating will alone 
produce a rash at any other time, and upon any other occa- 
sion. 

This complaint is justly dreaded, as it has proved fatal, in 
this situation, when in the extreme; although a slight attack 
of it may be got over without danger. It was very common, 
when sweating, and long confinement in bed, and heating 
things, were in vogue; and is much less so since the cool treat- 
ment has been introduced. Those of weak and delicate habits 
seem more liable to this complaint than the strong and heal- 
thy. 

SWELLED LEG. 

Child-bed women are liable to a very peculiar disease, of 
which, a swelling of the lower extremities, preceded and accom- 
panied by great pain and difficulty in moving, are the most re- 



243 

markable symptoms; not appearing connected with any pecu- 
liarity of constitution or preceding complaint, nor the kind 
preceding labour, or on the treatment before or after child-birth. 
It occurs at any period from the first or second day, to two or 
three weeks after delivery; it is preceded by general uneasiness, 
lowness of spirits, slight pains about the womb, with a dis- 
charge from it peculiarly offensive, These symptoms' seldom 
command much attention, until the patient is seized with pain 
on the inside of the limb, commonly about the calf of the leg, 
which soon extends from the heel to the groin, along the course 
of the vessels called absorbents. The limb soon after begins to 
swell: the soreness extends all over it, so that it cannot bear the 
slightest touch, and every attempt to move gives exquisite pain; 
the skin becomes glossy and pale, the countenance is expressive 
of great anguish and dejection, the pulse is quick, the heat of 
the skin increased, the tongue white, and the urine muddy. 

These symptoms strongly mark the presence of some acrid, 
irritating matter; and no doubt it is in the womb. The pre- 
vention must depend on cleansing the birth-place, injecting wa- 
ter with such force as to enter and cleanse it: also, keeping 
powdered charcoal in the birth-place. 

The cure of this complaint is often tedious; sometimes the 
other leg takes on the disease, as the first subsides. Gentle 
evacuations, keeping the bowels open, bathing the limb in 
sweet oil, and in oil and laudanum in equal parts, is always 
proper. Laudanum may be taken to procure rest, when the 
pain is violent. Dr. Hosack, of New York, and other physi- 
cians of eminence, recommend strongly taking about two 
grains of calomel, mixed up with the like quantity of squills, 
made into a pill, to be taken every night, and morning also, if 
there be no excessive purging. The moment this disease be- 
gins, I would recommend the immediate cleansing of the birth- 
place, using a strong syringe to inject up water; a table spoon- 
ful of the finest powdered charcoal, mixed up with sweet oil or 
yeast, should, after the washing, be also injected up, and re- 
tained for some time by a plug or the hand. This will prevent 
the discharge from becoming so offensive, and lessen the irri- 
tability of the part, inclining it to absorption. 



244 



MANIA OR MADNESS. 

The peculiar connection between the womb and the head, 
was before stated; in consequence of this connection, women 
after delivery are very subject to head-aches and to madness. 
There is some difference in the treatment of this disease after 
child-birth. The patient under derangement does not require 
the evacuations used for this disease on other occasions. Mo- 
derate bleeding' is proper, if the pulse be active, with purging. 
It is advisable to lose blood by frequent cupping: issues in 
the back of the neck are said to be of more use than blisters in 
this disease. Frequent vomits are very proper; but the great- 
est attention should be paid to restoring the womb to its natu- 
ral action, menstruation. For this object, the purges should 
be of aloes: sitting in hot water; irritating, by injecting a little 
brandy and water up the birth-place; blisters on the thighs, or 
one near the fundament, will be found of powerful efficacy in 
restoring the menses; with all the other means mentioned 
while treating on that subject. 

Women in this state should be treated with perfect gentle- 
ness; thwarted in nothing not injurious. Travelling, change 
of air, and the salt bath, will all tend to restore the intellect 
as well as the body to a natural state*, 



245 



DISEASES OF CHILDREN. 

The treatment of the disorders of children, ought to be un- 
derstood by every mother; as well for the purpose of giving oc- 
casional relief, when a physician cannot be had, as to prevent 
injudicious meddling with their complaints. Improper doses, 
at improper times, have probably caused the death of as many 
children as have been relieved by medicine. 

The first thing to be impressed on parents' minds, is that 
the bodies of their children are governed by the same laws as 
their own; and the cure of their disorders is to be effected, not 
by doses operating as charms, but by the application of the prin- 
ciples of medicine to their particular cases. The great variety 
of prescriptions for the diseases of children, in almost every 
woman's head, should be abandoned; but few medicines, and 
those of the most simple kind, are wanted for them. 

In commencing the subject of the treatment of the diseases 
of children, you will excuse me for again repeating the means 
of preserving their health. To some I know it will appear ve- 
ry superfluous; but on others, slow to believe and hesitating to 
act, it cannot be too often pressed. Much of the intellectual 
pre-eminence, most of the good dispositions of children, as well 
as the vigour of their bodies, depend on exemption from dis- 
ease: and hence the subject becomes more than doubly interest- 
ing. Fray, then, never permit an infant to breath a foul, cor- 
rupted air. — It is to them more poisonous than to adults. — 
Keep them in perfect cleanliness, by daily washing; and make 
them sleep on beds of finely powdered charcoal, or their secre- 
tions will putrify and irritate their bodies. Early begin to es- 
tablish habits in their systems, and these will aid in repelling 
disease. Their constant efforts to use their limbs, point out 
the propriety of never incumbering them with unnecessary 
clothing, and of giving them exercise daily; and when in the 
nurse's arms frequently change the position, as their being held 
more on one side than another, may tend to injure the part. — 
Give no medicines, unless absolutely called for by disease, 



246 

and never but of the most simple kind. Let their nourishment 
be of the most common, the most readily obtained food, with 
as little mixture as possible. Regulate their sleep so that least 
disturbance shall be given at night. In making all changes, par- 
ticularly in diet, be very gradual, especially at the time of 
weaning. 

From the moment a child is born, its system assumes more 
or -less an inflammatory state: its diseases are almost always 
those of high action; requiring slight evacuations, and nothing 
of a heating nature. The swelling about the head, the injuries 
about the face, scratches, &c. usually go off without any assis- 
tance from art. The sore left by the separation of the navel 
cord, requires no other treatment than that of the most simple 
kind. The Hare Lip requires the attention of a surgeon: the 
Tonguetied, as it is called,, should also be referred to him. 

Dr. Thomas says, that the symptoms of the first diseases of 
infants, (by which we judge of their nature,) are, chiefly, sour 
belchings, sickness, vomiting, purging, inquietude, crying, 
wakefulness, heaviness, loathing of food, contractions and 
sharpness of the features, blueness about the mouth, turning 
up of the eyes, sudden startings from sleep, thirst, heat, the 
manner of breathing and of crying, drawing up of the lower ex- 
tremities, hardness and distension of the belly, eruptions on 
the skin, and in the mouth, and relaxation or contraction of the 
skin, &x. 

SUSPENSION OF LIFE. 

Children are sometimes born apparently dead, particularly in 
slow labours, and when the navel cord is compressed. In such 
cases, after cleansing and wrapping it in warm flannel, you 
should stimulate its temples and nostrils with spirit of harts- 
horne, and rub its head and breast with ardent spirit. If these 
means fail to excite the languid circulation, you should endea- 
vour to inflate the lungs by blowing through its nose, while you 
hold its mouth, unless a pipe or catheter can be procured to 
blow in its mouth. The application of a little cold water to 
the child's chest, should also be tried. 



When any portion of matter appears to obstruct the child's 
mouth or nose, you should endeavour to extract it, and wash 
the mouth. Sometimes it has been found of importance to un* 
tie the navel cord, and suffer the loss of a little blood. At all 
events, you should never fail, not only to try all the means men- 
tioned, with gently rubbing the body, but they are to be con- 
tinued two or four hours, as even after that time, life has in 
such cases been restored. 



THE BLACK OR LIVID COLOUR OF INFANTS. 

It sometimes happens that immediately after birth, the face 
and neck of the infant put on a livid or black appearance: the 
lips become purple, and the breathing short; which symptoms 
generally soon go off, or terminate in death. This is attribut- 
ed to some defect in the formation of the heart or lungs. 

Dr. Hosack recommends a stimulating bath made of four 
ounces of powdered Peruvian bark, (oak bark will answer as 
well,) to be boiled for a few minutes in about two gallons of 
water; to this he then added a pint of Jamaica spirit. When 
it was cooled to a degree rather above that of the body, the 
child was immersed in it up to its neck; and, to render it more 
stimulating, a small quantity of spirit of hartshorne, or ammo- 
nia, was added from time to time. The child, on shewing 
symptoms of recovery, is to be removed, and wrapped up in 
warm, dry flannels; but if the fit recurs, the bath is to be again 
applied. 

OF COLDS AND SNUFFLES. 

In the first month, most children are affected with colds; com- 
monly in the nose, and called snuffles. Warming the feet at 
the fire, will often be sufficient to cure them. But when the 
disease is attended with fever, it is best to administer a vomit. 
This may be of three grains of ipecacuanhae, or of one grain of 
tartar emetic, in four table spoonfuls of warm water, and one 
tea spoonful to be given every twenty minutes, until vomiting- 



248 

is produced. The bowels should be kept open with magnesia, 
rhubarb, manna, or castor oil, in small doses. I would recom- 
mend a repetition of the vomit, if the first do not relieve. 

ERUPTIONS OF THE SKIN. 

Children, particularly those not daily put in a tub of warm 
water, are very subject to a great variety of eruptions on their 
skin, commencing sometimes in the first week of their birth. 
Different names, as red gum and white gum, are given to each 
kind; but it is useless, as they vary much, and require nearly 
the same treatment. In the red gum, there is a number of 
small elevated red spots, scattered over the trunk of the body, 
and sometimes on the cheek or forehead; on the feet the spots 
are still larger, and contain occasionally a clear fluid. In some 
stages it resembles the measles. Generally no medicine is re- 
quisite; but if it suddenly disappears, and the child shows 
symptoms of internal disease, an emetic or purgative ought to 
be given, and repeated, if not at first relieved. The white g-um 
appears after the red gum, resembling the itch, with white, 
shining little blisters, containing a little clear fluid. There are 
other varieties of these eruptions of the skin, but few of them 
require medical treatment. A vomit or purge, to clear the 
bowels, generally relieves. The prevention is in great cleanli- 
ness, free washing daily in soap and water, with regularity in 
nursing. When these affections of the skin are attended with 
fever, they require treatment, such as for common fevers, with 
applications to the parts inflamed, to lessen the action; cold lead 
water and sweet oil, are the best for this purpose. 

SORE EYES. 

Children are very subject, sometimes during the first month, 
to inflammations of their eyelids and eyes, particularly those 
whose parents neglect the great preventive of their complaints, 
setting them every morning in a tub of warm water. At what- 
ever time the inflammation comes on, in slight cases, cold water 
alone; after a few days, a very weak solution of sugar of lead, 



249 

fifteen grains to the pint of water, should be applied every two 
hours to the part. If it do not speedily subside, a purge of oil 
should be given, to relieve the inflammatory state of their bo- 
dies. The inflamed eye should never be turned towards the 
fire, and the hand of the infant so confined, as to prevent rub- 
bing the part. In cases where the inflammation of the ball of 
the eye is great, a leech should be applied to the eyelid: also, 
cupping about the temples; and if the child be a few months 
old, bleeding four or five ounces may be necessary to save the 
sight of the eye. 

This cold and lead water alone is the proper application to 
the eye, and nothing should be added excepting where the eye- 
lids adhere together. In this case, the mildest sweet oil, mild 
hog's lard, or any bland grease, should be applied to the edges. 
A want of the knowledge to cool, and evacuate at once, and ef- 
fectually, the children, and avoid every stimulating application, 
in inflammations of their eyes, has been the cause of the fre- 
quent loss of their vision. I trust, that no parent, hereafter, 
will suffer any other application to their children's eyes, unless 
from the recommendation of some eminent physician. 

SWELLINGS, EXCORIATIONS. 

For any swelling of an inflammatory appearance, marked by 
red colour, heat, and pain; the part should be bathed in a solu- 
tion of lead, of thirty grains to the pint of water, and a rag wet 
with it be constantly applied. When the inflammation is con- 
siderable, purging is proper; also bleeding near the part, by 
cupping or leeches. When the skin is rubbed off, (termed ex- 
coriation,) as is often the case, between the legs, behind the 
ears, in the hair, between the toes or fingers; this lead water 
should be applied, and sweet oil. In cases of inflammation, a 
poultice of Indian corn meal, wet with this lead water, and 
kept applied to the part, will expedite the cure. When sores 
have been of long standing, you should, by all means, on drying 
them up, purge the child once a week, for three or four weeks 
afterwards; also, diminish its food. The neglect to do this, or 
fo make a slight issue or sore, by means of a small blister plas- 
F f 



n 



250 

ter, applied and kept to some part of the body, two or three 
hours every day, for a week or two, has often been fatal; as the 
system, when the old sores are healed, not having its accus- 
tomed irritation, takes on violent disease in other parts. 

WIND UPON THE STOMACH AND BOWELS. 

A child is discovered to have wind upon its stomach, by the 
wind often rising in its throat, which makes it struggle at 
times, as if to get its breath, and from which it is occasionally 
relieved by the breaking of wind upwards. When it often re- 
curs, it is teazing, and interrupts rest. It is most common with 
children dry-nursed. 

A variety of articles have been given to dispel the wind; but 
none of them are to be compared to spirit of hartshorn: three 
drops in half a table spoonful of cold water* and repeated two 
or three times in the day, or as there may be occasion. Harts- 
horn, when it will answer the purpose, is to be preferred to cor- 
dials, spirits, seeds, spices, and hot things of any kind; as, al- 
though it is fully as powerful in dispelling the wind as any of 
them, it will not, by a permanent heat, nor by repetition, in- 
jure the stomach as they do; nor can any bad habit or other 
disadvantage arise from giving and repeating it as often and 
long as it may be necessary so to do. It is endowed with a 
property which makes it a desirable medicine for children; 
which is, it corrects and removes acidity or sourness, a princi- 
pal cause of griping with children. Its use in these intentions 
is well known by grown up persons, with whom it is a favour- 
ite and familiar medicine: and the reason why it is not extend- 
ed more generally to children, proceeds, I imagine, from a sup- 
position that it is too strong for them; but which is a mistak- 
en notion; as it may be given, as above directed, with the ut- 
most ease and safety. The dose here mentioned is the small- 
est that need ever be given, and it may be increased, as a child 
grows older, five or six drops. 

As wind upon the stomach is, with a child as well as a 
grown person, to be considered as a mark and indication of a 
weak stomach and indigestion; so it will be observed to be 



251 

most common and troublesome to those children who are dry- 
nursed, and fed with food of an improper quality, as bread, 
thick and rice milk, &c, which cannot digest and pass the sto- 
mach so perfectly and readily as it ought to do: for we all 
know, that whatever is heavy of digestion, and lays long upon 
the stomach, is not only uneasy, but also causes wind there; 
and cannot but be sensible how much these painful sensations 
would be increased, if we were compelled, as infants are, to a 
constant repetition of the food which occasioned them. Many 
weakly, puny children, who are even wet-nursed, will now and 
then be observed to have wind upon their stomachs; (and the 
hickufi, which they all have at times, is occasioned by it); as 
also those who are most carefully fed in dry-nursing; but when 
it occurs only now and then, and that slightly, it is not worth 
notice; and if any attack of it should seem more severe than 
usual, the hartshorn and water will most likely relieve it. The 
occasions which call for a more particular attention, are those 
where the child is dry-nursed, takes food unwillingly, and swal- 
lows with difficulty, from the wind rising into its throat, and 
that for some successive days. Whenever, therefore, the com- 
plaint appears in this latter form, it will be necessary to pay 
the strictest attention to the food, and by no means to force 
more, even of such as is the most suitable, than it is disposed 
to take willingly. If it be costive, it will be proper to give a 
little manna, or a tea spoonful of castor or olive oil. 

Children, like grown up persons, seldom have wind in their 
bowels without being griped by it; but which they will some- 
times have, without being either costive or too loose in their 
bowels. When it so happens, it most commonly proceeds from 
cold, and will generally go off in a short time. The hartshorn 
may in this case be tried, although its effects will not always 
be so striking as when the wind ^s in the stomach; and if it 
does not answer, recourse may be had to a little geneva and 
water, or anise, or fennel-seed tea, &c. If these fail, and the 
complaint increases, it must be treated as a griping without 
looseness. 

Some children seem naturally more subject to wind in their 
bowels than others; and which can be accounted for no other- 



25& 

wise, than as proceeding from a particularly weak and tender 
state of those parts. And as it is much increased by cold, a 
particular attention must be paid to keep and defend those 
children who are liable to it, from taking cold, by a proper re- 
gard to the closeness and warmth of their dress, and by keep- 
ing them out of the air in the first or second month. 

A SICKNESS, WITH OR WITHOUT THROWING UP. 

Infants are very subject to a sickness the firstor second week. 
Sometimes they throw up with it; and at other times they do 
not, but lie in a dozing state, without motion, the lips pale, and 
a paleness and sinking of the face; and they generally refuse 
their food, or do not take it so freely as at other times, seem- 
ingly owing to their being stuffed and full at the stomach, and 
not able to get it down. The stomach commonly feels hard, 
and is sensibly swelled and enlarged. 

A throwing up, or possetting, as it is commonly termed, is 
seldom esteemed an unfavourable circumstance with young chil- 
dren: yet the sickness that happens at this early period, is ge- 
nerally from a widely different cause with the possetting, which 
rarely happens so early; and when it does, proceeds from a na- 
tural and not unfavourable cause; whereas the sickness that 
comes on at this time, is not desirable. In possetting, what 
comes up, is in a digested state; whereas what comes up at this 
period, and upon this occasion, is scarcely changed or altered 
from what it was when it went down: and if altered, appears in 
hard curdled lumps. From which, it clearly appears, that the 
cause of this sickness, is the food taken, which disagrees, and 
therefore will not digest and pass the stomach as it ought to 
do, but remains unaltered till nature relieves herself by a sick- 
ness, or looseness; but until this takes place, and while the food 
stays upon the stomach, it lies there as an oppressive load, 
which accounts for the child's looking so pale, and otherwise 
ill. This sickness at stomach, without throwing up, is a very 
common cause of alarm and much uneasiness and anxiety to 
the mother and friends, who suppose the child, from the ap- 
parently great and oftentimes sudden alteration in its look, must 



£53 

be in a dangerous situation; although, notwithstanding the 
alarming appearances, it is very rarely attended with immediate 
danger; and, when the cause is known, may be readily removed 
and a return of it prevented. The means to be pursued for 
these purposes are, first, to remove the load from the child's 
stomach, which will give immediate relief, as will be perceived 
by its resuming its former look; and this will often be done, 
by giving it a tea spoonful of castor oil, or a little manna, so as 
to obtain a free passage, which may carry the complaint off' by 
stool; but if this should fail, an antimonial puke will scarcely 
fail of fulfilling the intended purpose. To prevent a return, the 
child's food must be strictly attended to; and if (as is generally 
the case) it happens before the child gets the breast, it had bet- 
ter not be fed again until it can have the breast: but if food or 
nourishment be absolutely and immediately necessary, it must 
be given of such kind as may be reasonably expected to agree 
better, and such as has been advised when treating of food and 
diet. 

This complaint is a common attendant, or rather forerunner 
of gripes and looseness. It is more rare and less frequent 
with those who are not fed before they get the breast; and 
when they come to have the breast plentifully, and take it 
freely, they seldom have any returns of it. It is not, as before 
observed, immediately dangerous; yet if it be neglected, by suf- 
fering the cause of it to be repeated and continued, it may lead 
to severe gripings and looseness, that may, and often do, prove 
fatal. 

The sickness and oppression at the stomach, will always oc- 
cur in a greater or less degree when a child gets, the day it is 
born, the breast of a nurse instead of that of its mother. This 
strongly points out the impropriety of interrupting the order of 
nature in her own invariable operations. Man has a disadvan- 
tage with the rest of the animal creation, in this and some other 
of the simple operations of nature, which seldom errs, except 
when interrupted by the art of man. It seems highly probable, 
that could those children who are intended to be brought up by 
hand, be indulged with a breast for three, two, or even one 
xnonth, from their birth, their stomachs and bowels would, in 



251 

that time, acquire so much strength as to prevent the com- 
plaints, either altogether, or in a great measure. 

THRUSH, OR SORE MOUTH. 

This is a complaint to which children are subject. It is 
commonly called a sore mouth, which it really proves to be to 
the poor infant, as it is mostly attended with a good deal of 
pain and uneasiness, especially in feeding — in sucking, most 
particularly. The appearance in the mouth is as if the child 
had been eating curds, and that some of them remained stick- 
ing upon the tongue, to which the complaint and soreness are 
at first chiefly confined; but afterwards it will spread over the 
inside of the mouth, and be extended to the throat, stomach, 
and bowels. Whenever any white specks, or matter like curds, 
are observed to be sticking upon the tongue, so fast as not to 
be readily washed or rubbed off, it may justly be supposed the 
sore mouth is commencing. 

If the child at this time is in the least disposed to be costive, 
a little manna, oil, or magnesia, must be given, to procure one 
or two loose stools; and, which may be repeated afterwards, if 
the body does not keep open. It will be necessary to have the 
tongue frequently cleaned; for which purpose many things are 
recommended, as honey, borax, alum, white vitriol, &c. Bo- 
rax is to be preferred to any thing else, as it is very effectual 
and much safer than the others. It must be powdered, with 
or without an equal quantity of loaf sugar; and is to be made 
use of by tying a piece of linen rag upon the mouth or shank of 
a tea spoon, which must be dipped in the powder, and the 
tongue rubbed with it two or three times a day; and it must be 
regularly persevered in daily, while any appearance of the com- 
plaint remains; although, in doing it, the child will receive 
some pain, especialty if the complaint had been suffered to in- 
crease before proper attempts were made to remove it; but 
when taken at the beginning, the mouth will be kept tolerably 
clear and free, without paining the child; and it will be enabled 
to feed with much more ease, and the complaint will be got rid 
of in the course of seven or eight days. The colour of the 



255 

specks upon the tongue are, as has been observed, at first white; 
yet it is common for them, when the complaint is of some 
standing, to turn yellowish and brown; upon which occasions 
they generally come off at last, in sloughs. 

When from neglect, or any other cause, the complaint has 
continued for some time, it is very common for the child to 
have a degree of fever, very often accompanied with griping 
and looseness, with watery, sour, green stools ; in which case 
the disorder becomes more alarming and troublesome. 

This complaint is occasioned by an imperfect or improper 
digestion of the child's food; and therefore it will be very ne- 
cessary to pay a strict attention to the diet at this time, if the 
child be dry-nursed ; to the mother's or nurse's diet, if other- 
wise. 

When the looseness is great, the complaint must be treated 
as from any other cause. Of all medicines, the antimonial puke 
is most eminently serviceable in this state of the complaint, and 
is often attended with the happiest effects, and therefore ought 
not to be omitted: it may be given once a day, while the com- 
plaint continues; as it commonly operates both upward and 
downward, it removes the offending matter from the stomach 
and bowels, which is the cause of the complaint, and also of the 
fever; by which means the most sensible relief is obtained. 

When the thrush is neglected, and suffered to continue until 
it is communicated to the bowels, (as it begins first in the 
mouth, and is extended gradually and regularly downward,) the 
stools will frequently be so irritating as to inflame the child's 
backside, and make it sore. When this happens, the parts red 
and sore must be kept as clean as possible, and often washed 
with cold water. And, if the soreness increases, it will be pro- 
per to bathe them with lead water and oil. 

The thrush may be communicated to a child by a nipple 
that has been in the mouth of another child who has the com- 
plaint. 

The cause of this complaint has not been yet generally 
agreed on. During many years particular attention to it, I 
have scarce ever seen a case, when a child was dry-nursed, with- 
out more or less of the complaint, but most commonly with 



256 

little severity, where means were made use of to remove it.—- 
On the contrary, I have never observed the least appearance of 
it where the child had no other food from his birth but the 
breast. I have frequently observed it when a child has been 
fed with improper food, till the breast was ready for him; and 
much seldomer when he has been so fed with more proper 
food: from which I have long concluded that the cause is im- 
proper food; and that the complaint may be ranked with ma- 
ny other injurious consequences (already named) from the 
same baneful cause. 

YELLOWNESS OF THE SKIN. 

A yellowness of the skin, which very often overspreads the 
whole body, is common with infants a few days after they are 
born; it sometimes continues for some weeks, during- which 
time it often becomes of a deeper yellow, or orange colour. It 
is not to be regarded, nor is any thing needful to be done to re- 
move it, as it will disappear totally and spontaneously at last. 
It is commonly said that the skin is left clearer and fairer by 
it than it otherwise would be without it; which seems a doubt: 
however, it is an agreeable delusion, and may help to reconcile 
so unpleasing an appearance. Sometimes a slight laxative or 
vomit will be requisite. 

MILK IN THE CHILD'S BREAST. 

Some children will have milk in their breasts a few days af- 
ter birth, and which is commonly pressed out by the fingers of 
the nurse. If the breasts be much swelled and inflamed, this 
pressure, if forcible, will give considerable pain, and may be 
attended with worse consequences, and more uneasiness to the 
child, than can happen if nothing be done: and if the swelling 
be trifling, forcing out the milk is less necessary. In all cases, 
pressing it out is better avoided; and any swelling and hardness 
that may happen, will be better relieved by a little olive or 
goose oil, rubbed gently on once or twice a day; the milk being 
left to disperse or discharge itself naturally — the latter of which 



257 

often happens, with the most trifling assistance; and whenever 
assistance by pressure is given, it should always be of the most 
gentle kind. 

LOOSENESS OF THE BOWELS. 

This is generally brought on by too much, or unsuitable 
food; in which case great attention should be paid to the regu- 
lation and selection of the diet. In other cases, it may arise 
from disease in the bowels, which will require an emetic; a. id 
the bowels are to be cleansed by a purge of a little rhubarb and 
magnesia; to be followed by small doses of chalk in some mu- 
cilage, as milk — made more palatable by a drop or two of the 
oil of peppermint, cinnamon or aniseed. If the stools continue 
more frequent than they ought to be ; and are either slimy or 
tinged with blood, the purge should be repeated : warm appli- 
cations are to be made to the belly, the skin gently rubbed; and 
the diet should be of mucilaginous articles and jelly. Some- 
times the application of a small blister to the pit of the sto- 
mach is of great service. In cases where the strength is fast 
sinking, glysters of a little opium and starch should be given; 
and laudanum may be rubbed on the belly, with sweet oil. 

FALLING OF THE FUNDAMENT. 

The end bowel of children of lax habits, is very apt to pro- 
trude after a stool. It is a source sometimes of great pain, 
and often of great uneasiness. In general it may be replaced 
by the application of a rag wet with cold water, using very mo- 
derate compression. More obstinate cases require that the 
child should be laid on its belly: the sides of the buttocks mo- 
derately dilated; and then the fingers of the hand are to be ap- 
plied, so as equally to cover the protruded part; then gradually 
and firmly, in one continued pressure, the part may be caused 
to draw up. In some cases, it has been found expedient to in- 
troduce some gut, distended with air, and when it carries up 
the fallen bowel, on letting out the air, it retracts, and may be 
withdrawn. Whenever the bowel protruded is inflamed or 



258 

painful, it should be bathed in cool water, or lead water, or 
olive oil, or hog's lard. Sometimes fomentations of mild arti- 
cles, as flax-seed poultice, hot water, &c. are of service. 

Those children much subject to this complaint, should ne- 
ver be allowed to strain in evacuating the bowels. The dis- 
charge had best be made in an erect posture. The strength of 
the bowel may be restored by injections of decoctions of oak 
bark, or nut galls: when the irritation is great, a little lauda- 
num will lessen it. Pouring cold water occasionally on the 
buttocks, and always after a discharge washing in cold water, 
will be found serviceable. 

OF CHOL1C. 

Some children are very subject to cholic, which is easily dis- 
covered by sudden fits of crying or screaming, which nothing 
can appease; the child bends back the body, spurs with the feet, 
and then has an abatement of the pain for a few minutes, ob- 
tained sometimes by the discharge of wind. An attack may 
consist of one uninterrupted fit, or of repeated screaming, with 
intervening moments of ease. It may be induced by costive- 
ness, by cold, by damp clothes, by the liberal use of panado, 
particularly if made of sour bread; by passion, or some state of 
the nurse affecting the milk, by collection of wind in the bow- 
els; or it may accompany thin and slimy purging, which is 
sometimes produced by the injudicious use of laxatives. 

In ordinary cases, nurses give gin and water, which is a most 
injurious practice, and may in some instances kill the child. 
Laudanum gives speedy relief, but it weakens the stomach and 
nervous system, and produces costiveness. A few drops of 
tincture of asafoetida, mixed with oil of anise, is generally ef- 
fectual, and is always safe.* The warm bath is useful, and if 
these means do not give relief, rubbing the belly with lauda- 



* " Two drachms of tincture of asafoetida, twenty drops of oil of anise, 
and an ounce of mucilage of gum arabic, may be rubbed up together: 
and of this mixture, from ten to twenty drops, in a little water, will be ?, 
proper dose." 



259 

iium will be safer than giving it internally. A clyster of gruel 
and a little oil, is proper, and particularly cloths dipped in hot 
water and applied to the belly; and if the child has been costive, 
it will be right to give a tea spoonful of castor oil, after these 
remedies have relieved, in order to prevent a return. 

When children are subject to cholic, we may suspect that 
there is something wrong in the diet. Common panado, espe- 
cially if it contain much sugar, is very apt to have this effect. 
The nurse's milk may also be flatulent, and this bad property 
is sometimes increased by the use of porter or ale, intended to 
increase the quantity. The state of the "child's bowels must be 
attended to, and it should not be allowed to load the stomach, 
by taking too much at a time. If it discharge wind upwards 
after sucking, it should be gently dandled, as that promotes ex- 
pulsion. I am no advocate for giving much medicine to chil- 
dren: but when these means do not succeed, it is proper to give 
occasionally a few drops of the mixture mentioned in the note. 
The fundament should.be kept open, by introducing a covered 
quill, as before suggested. 

In the more violent and dangerous kind of cholic, the belly 
is tumid and painful to the touch, to a greater degree than in 
the former species; the child is hot, the pulse quick, the face 
flushed, the pain and screaming violent, and sometimes there is 
great straining, and nothing passes but bloody slime. As this 
may proceed from inflammation or obstruction in the bowels, 
means should be taken to procure a stool by a clyster and the 
use of castor oil or calomel, at the same time that the child is 
put into the warm bath and rubbed with laudanum. If the 
bowels be open, a clyster containing a little laudanum, can sel- 
dom be improper, if medical aid cannot be early obtained.— *• 
Also, try the antimonial puke. 

OF CONVULSIONS. 

Convulsions take place at any age, and may occur either in 
the course of some other disease, under which the child has 
been labouring for some time, or suddenly, in a state of pre- 
vious health. In the one case, they are highly dangerous, and 



£60 

often indicate a fatal issue; in the other, they are frequently at- 
tended with little hazard. Convulsions vary in degree, from a 
slight movement of the muscles of the face, to a rigid, or con- 
vulsed state of almost the whole body. In general, whatever 
be the degree of the movement, the countenance is altered, both 
in colour and expression: the patient is insensible, and cannot 
follow an object with the eye. In some instances, the motion 
is so slight, that the child may rather be said to be in a state 
of fainting, or stupor, than of convulsion. In very young in- 
fants, there is sometimes only a smile about the mouth; the 
eye, which is half closed, turns slowly round, the breathing 
seems occasionally to flutter, and the child starts, and throws 
out the arms on the least noise. These motions, called inward 
fits, frequently proceed from wind in the bowels. 

Convulsions vary in point of duration, as well as of violence. 
They sometimes go off in a few seconds; in other instances, 
they continue for several minutes. The child may have only 
one short attack, and become well immediately afterwards, or 
it may remain in a languid, sleepy state; or it may have re- 
peated attacks in a very short time, and continue insensible 
during the whole of the intervening period. Convulsions may 
be produced by wind, or irritation in the bowels, dependent on 
worms, costiveness, indigestible food, acrid stools, Sec; or by 
teething; or by breathing bad or confined air; or by the strik- 
ing in of some eruption; or during the coming out of others, 
such as small-pox; or by affections of the brain itself; or by 
other spasmodic diseases, such as hooping-cough, See. It will 
be useful to observe, 

First: That when the child has been ill for some time before 
convulsions come on, especially if the pulse has been quick, the 
skin warm, and the head affected, whilst these symptoms could 
not be traced to the effect of teething, there is ground to be- 
lieve, that the convulsions proceed from a diseased state of the 
brain. It is to be hoped, that every attentive parent will, from 
the previous symptoms, have been led to procurefor her 
child professional advice, before this period of the disease. 

Second: In the case of very young infants, if there have been 
no preceding disease, there is great reason to attribute the con- 



£61 

vulsion to the state of the bowels: and we shall be confirmed 
in our opinion, by finding that the stools are not of a good ap- 
pearance; that there is much wind in the bowels; that the child 
has not been nursed or fed properly; that the nurse has been 
agitated by passion, or committed some irregularity in diet; or 
lastly, in infants a few days old, that the meconium is not ex- 
pelled. 

Third: When young infants have convulsions from the state 
of the bowels, we generally find that the face is pale and the 
motions slight; but if they proceed from the state of the brain, 
which is still more alarming, the motions are stronger, and 
more deserving of'the name of convulsion. 

Fourth: At this early period, children, from an irritated state 
of the navel, when the cord drops off, and also from affections 
of the nervous system, may have locked jaw, and the spine 
stiffly bent back by a convulsion. 

Fifth: After the child is two months old, irritation of the 
bowels, proceeding from bad stools, worms, or indigestible 
foQd, does not produce those gentle motions, or that apparently 
languid state, observable at an earlier period, but generally ex- 
cites pretty strong and well marked convulsions; and therefore, 
after this time, the distinction mentioned in the third observa- 
tion will not hold good. 

Sixth: At the period when children are teething, convulsions 
may be produced by irritation of the gums, more likely than 
by other causes; and, therefore, we should in every case which 
occurs at that time, examine carefully the state of the gums, 
and cut them if there be the slightest swelling or sign of 
teething. 

When a child is seized with convulsions, a great consterna- 
tion immediately prevails, and without some determinate rules, 
either nothing will be done, or very contradictory plans may be 
adopted. 

The first general rule in such cases, is to order the warm 
bath, which is proper in every instance. When the motion is 
strong, it always allays it; when it is slight, it brings on a quiet 
state of repose. The water should be agreeably warm to the 
hand, and the child be kept in it up to the neck for some mi- 



nutes, should it not get relief sooner. If it be very pale or lan- 
guid, the addition of a table spoonful of mustard, spirit, or 
h..( cshorn, to the bath is useful. 

Second: Whilst the child is in the bath, a common injection 
is to be prepared, and administered immediately after it comes 
out; and afterwards a dose of calomel, proportioned to its age, 
is to be given. 

Third: If the child seems to be sick, or oppressed in its 
breathing, or about the stomach, or has been known to have 
had something which has disordered the stomach, vomiting 
should be excited, by tickling the throat with a feather, dur- 
ing the fit, or by giving ipecacuanhae, as soon as the child can 
swallow. 

Fourth: After taking the child out of the bath, it will be use- 
ful to rub it, particularly over the spine and the stomach, with 
oil of amber, or with spirits, having about a sixth part of harts- 
horn added. If any rash has struck in, rubbing the surface 
with camphorated spirit or oil of turpentine, or applying a 
small warm plaster over the stomach, will be useful. 

Fifth: If the face be flushed, or the head be large, or the child 
remain insensible or stupid, it should, according to the age of 
the child, be bled at the temples. The head ought also to be. 
shaved, and covered with a blister. At the same time, it will 
be proper to give such doses of calomel, as will keep the bow- 
els very open. This is more especially necessary, if the stools 
be foetid, or of an unnatural appearance. If the child remain 
languid or insensible, it will be beneficial to rub the surface fre- 
quently with oil of amber, strong spirits, or camphorated oil 
of turpentine. When there appears to be much irritation, rub- 
bing the back-bone with laudanum is proper, but no opium 
should in general be given internally. 

When there is a tendency to frequent returns, it will be pro- 
per, besides keeping the bowels correct, by means of calomel 
or rhubarb and magnesia, to give repeatedly a few drops of 
tincture of asafoetida, mixed with oil of anise. In all cases, the 
strength is to be supported by suitable nourishment, even by 
clysters of beef tea. 



263 

Sixth: The directions given, are particularly applicable to 
the convulsions of children above a week or two old. I may- 
add, that although the same remarks may often apply to those 
who are younger, in general, the convulsions or inward fits of 
infants a day or two old, require chiefly gentle laxatives, such 
as magnesia and rhubarb, and sedulous attention to nourish- 
ment, with gentle friction over the surface, especially of the 
belly, with camphorated spirit. 

Seventh: When fits are apprehended in dentition, from start- 
ing, feverishness, and other circumstances, ascertained by for- 
mer experience to have preceded convulsions, the gums should 
be cut, and a gentle emetic exhibited. Laxatives and the 
warm bath are also useful, and these means generally prevent 
the fit. 

FEVER OF CHILDREN. 

Fever, proceeding from different causes, is a frequent disease 
of children. It is either produced speedily, after eating some 
improper and indigestible food, or the foundation is laid more 
slowly, by a previous state of costiveness, or disordered condi- 
tion of the bowels. In the first case, it sometimes attacks very 
suddenly, after eating unripe fruit, or garden trash, or almonds, 
or pastry, and particularly that kind of cake, called short-bread. 
In other instances, the symptoms do not come on for a day or 
two. The fever generally begins in the afternoon; the child is 
not disposed to eat, is peevish, the hands are warm, and the 
pulse is quick; it complains when touched, although not hurt, 
and can hardly tell why. In the evening it becomes sick, or 
vomits, is very hot, restless, and thirsty, but generally the 
tongue is clean. Through the night, it is much disturbed. — 
Next day the tongue is furred or white, but the child is rather 
better and livelier in the morning. In the afternoon, however, 
the symptoms increase, and the disease goes on as the variety 
which I shall next describe. In some instances, the disorder 
attacks more speedily. The child, perhaps, when going out 
complains a little of the head, becomes worse when walking, 
and returns with a pain in the forehead, is pale, hot, and the 



864 

pulse quick, and if not soon relieved, has a very serious and 
obstinate fever established. The headach in this fever, de- 
pends on the state of the stomach. It goes off at times en- 
tirely, but always returns before a fit of sickness or vomiting. 

There can be no doubt as to the cause of this disorder, and 
there is little difficulty in checking it at once, by giving, on the 
first appearance of indisposition, a dose of ipecacuanha?, and 
afterwards a smart purge. If the emetic be delayed for some 
hours, or till next day, it may mitigate, but seldom entirely re- 
moves the disease. It is often astonishingly difficult in these 
fevers, to move the bowels. Large doses of physic produce 
very little effect: often, after being retained for some time, 
they are vomited. In this case, they must be assisted with in- 
jections. 

The other variety, the consideration of which will include the 
father treatment of the last disorder, begins often more gra- 
dually, the child being for a day or two unwell, before it be al- 
together confined to bed. In the day time, it has several at- 
tacks of feverishness, during which it is dull, languid, and dis- 
posed to lie down or sleep. In the intervals, it seems pretty 
well, but is easily put out of temper. The appetite is whimsi- 
cal, and it cannot eat what it asks for. It has but little thirst, 
and at this time the tongue is pretty clean. The bowels are 
generally bound, but sometimes loose, and in this case, the 
stools are offensive. These symptoms may continue for a day 
or two, or even for a week, before the child becomes so ill as 
to keep its bed, or to have a formed complaint. Then an acute 
paroxysm of fever takes place, generally preceded by shivering, 
and attended by vomiting; the pulse becomes very quick, and 
runs so high sometimes as a hundred and forty in the minute. 
The cheeks are flushed, and the child drowsy, but it has no 
pain in the head, nor any where, unless, perhaps, in the belly; 
for in some cases, it is sadly tormented with gripes, or even 
fixed pain in the bowels. The tongue now becomes foul, and 
the bowels appear to be very torpid, the appetite is totally lost, 
or what food is taken, is not digested. The stools are foetid, 
dark coloured, sometimes like pitch, or thin and olive coloured, 
or green and curdy-lboking. The breath is offensive. There 



265 

is a great desire to pick the nose and lips, so that sometimes if 
the child be not watched, an ulcer may be produced. The fe- 
ver does not continue alike severe during the whole day, but 
becomes less at times, though not at any stated hour. Each 
increase is attended with drowsiness. The face is occasionally 
flushed, and the eyes suffused; at other times it is pale, and the 
eyes dull and white. Generally delirium occurs in the course 
of the disease; but by speaking to the child, it can be recalled 
from this, and answers correctly: or, although sometimes de- 
lirious, yet for an hour or two, it may be tolerably distinct, 
and insist obstinately on being carried out. The debility in 
many cases is excessive, the child picking the bed-clothes, 
whining in a fatuitous manner, and staring vacantly; yet even 
in this state, it may often be roused, and seems to understand, 
at least so far as to reject what it dislikes. This disease runs 
on for a week or two, or even for several weeks, during which 
time, the appetite is very trifling, the thirst not urgent, the 
strength exhausted, the body wasted, and the feverish symp- 
toms varying a little, but not greatly, in degree. If the fever 
continue obstinate and violent, the belly become swelled, and 
the debility and stupor increase, the danger is great. 

This fever bears a resemblance to dropsy of the head, espe- 
cially in the commencement. But in such there is more fre- 
quent vomiting, and the pain in the head is generally severe; 
whereas, in this fever, there is either no pain, or it is evidently 
connected with the state of the stomach. By a careful compa- 
rison of these two diseases, in their progress, a practitioner, in 
most instances, may form a correct distinction. 

It is generally proper to commence the treatment of this dis- 
ease with an emetic of ipecacuanha, succeeded by a brisk laxa- 
tive. This practice, if adopted during the state of indisposi- 
tion which precedes the complete formation of the fever, will 
cut short the symptoms; and if laxatives be afterwards admin- 
istered, till the bowels are brought into a correct state, a per- 
fect recovery is the consequence. If, however, the fever has 
fairly taken place, we cannot expect immediately to remove it, 
but must be satisfied with a slower process. The great reme- 
dy, still to be depended on, for mitigating the disease, and 
Hh 



266 

abridging its duration, is purging, which is proper in every in- 
stance; for if the patient be not costive, the stools are at least 
unnatural. In some instances, the usual doses of medicine 
will be sufficient; but often the bowels are so torpid, that much 
larger doses will be required. This is a point of practice, 
which requires discrimination: for if the dose be not sufficient 
in quantity to purge, or if it be not repeated, so as to evacuate 
the morbid contents of the bowels, we come short of our ob- 
ject. On the other hand, if the purging be carried farther, we 
weaken our patient, and injure still farther the intestines. — 
Two circumstances will direct us in this matter: the state of 
the stools, and the effect on the pulse and on the strength.— 
When the stools are foetid, or unusual in colour or appearance, 
purgative medicines are necessary. When these remedies do 
not exhaust the patient, and render the pulse more frequent 
and smaller, they do good, and have not been pushed too far. 
With regard to the dose, that ought to be no greater than is 
adequate to the effect. At first it is useful, and often absolute- 
ly necessary, to give one or two brisk and large doses; but af- 
terwards, it is usually better to give only such doses as will 
keep the bowels open, and support their action. Where there 
seems to be much irritation or pain of the bowels, an opiate 
clyster may be also given occasionally, and with much advan- 
tage. The belly is likewise, if there be much pain or griping, 
to be fomented, and rubbed with anodyne balsam. 

During the use of purgative medicines, worms are frequent- 
ly expelled, which has given rise to a beiief that they occasion- 
ed all the symptoms, and hence this has been called a worm 
fever. That they may increase the disease, or, if in great quan- 
tity, may immediately produce it in some instances, I allow: 
but in many cases, they never appear, and therefore the appel- 
lation is improper. Wliether they exist or not, is not of so 
much consequence, as may at first appear; for it is by all ad- 
mitted, that the cause of the fever consists in a morbid state of 
the bowels, and that this is to be removed by purgative medi- 
cines, which are equally good for expelling worms. 

But although purging, under the restrictions I have made, 
be a proper practice, yet it is not the whole of our practice. In 



2Q7 

the early stage, we employ such other means as allay fever. 
When the heat of the skin is considerable and steady, sponging 
the surface with cold vinegar and water, is of service. Should 
this give much relief, and for a few minutes bring down the 
pulse, and abate the heat, .the cold affusion of water may be 
safely practised; but it is not to be repeated oftener than once, 
if it do not give more than usual relief; nor is it to be employ- 
ed with expectation of permanent advantage, unless immedi- 
ately after the hot stage has been fully established. 

Antimonial wine is useful, not to bring out a copious perspi- 
ration, but a gentle moisture, or softness on the surface. In- 
deed, in my practice, I constantly recommend repeated and 
continued doses of tartar in solution, to keep up slight sickness 
at the stomac*h. 

From first to last, light food must be given, in such portions 
as the patient can take. Panado, arrow-root, Sec. are very pro- 
per. Toast-water, whey, milk and water, lemonade, ripe fruit, 
&c. are useful for quenching thirst. 

Great attention is to be paid to cleanliness and ventilation; 
and when convalescent, a removal to the country is of npch 
benefit, in confirming the health. 

Young infants are subject to a variety of this fever, which 
begins with loss of appetite, restlessness, fretfulness, hot skin, 
quick pulse, and continual drowsiness, with bad smelled breath, 
and appearance of being hurt if touched or moved. There are 
generally distinct remissions, during which the child is easier, 
and takes the breast. There is no appearance of teeth, which 
distinguishes this from teething fever. It is more apt to be 
mistaken for dropsy of the brain: but in that disease, there is 
more impatience of light, heat in the head, screaming, or wak'- 
ning suddenly and in terror, &c, and in the advanced stage, the 
symptoms of oppressed brain are evident. The treatment is to 
be conducted on the principles already laid down, particularly 
by procuring stools; for it will generally be found, that the bow- 
els have been previously costive, or in a bad state. 

Children are also liable to the common nervous, or typhus 
fever. It is not unusual, when this disease gets into a family, 
where ventilation and cleanliness are neglected, for it to attack 



\J 



268 

in succession every one, from the eldest to the youngest. It 
approaches generally in a slow manner; the child looks pale and 
wan for a day or two, the appetite is impaired, the sleep unre- 
freshing, the skin of a dirty appearance, and the tongue white. 
Then a chilly fit comes on, or, without any great sense of cold- 
ness, the fever invades with a feeling of weariness and oppres- 
sion, the pulse becomes frequent, vomiting or squeamishness 
comes on, the head is painful, the skin hot, and the eyes deject- 
ed, or sunk. These symptoms have generally a remission, once 
in the twenty-four hours. Should the disease gain ground, the 
weakness increases, the pulse becomes more rapid, delirium 
takes place, and then the child sinks into a state of stupor, the 
eyes half closed, the teeth covered with a black crust, and the 
stools are passed without knowledge. This state ends in dis- 
solution in a fortnight or three weeks. 

In this fever, at the very first, an emetic is to be given, suc- 
ceeded by a pretty smart purge. If the skin be very hot and 
dry, and the child do not at the same time feel any chilliness, 
the affusion of cold water will be very serviceable in the early 
stage. But if this be neglected, or not practised, then you are 
to sponge the surface with cold water and vinegar. If the 
head be painful, one or two leeches, according to the age, are 
to be applied, in the beginning, to the forehead; and if the pain 
continue, and delirium approach, the head is to be shaved, and 
a small blister applied. If the skin be parched and hot, and 
the sponge afford no permanent relief, a little antimonial wine 
will be proper. The bowels are, during the whole progress of 
the fever, to be kept open, and occasional purges are of much 
benefit, when the stools are offensive or unnatural. When there 
is much oppression, and a dry, foul tongue, a smart dose of ca- 
lomel often gives much relief, by evacuating dark bilious stools. 
The diet should consist of stewed applies, beef-tea, panado, 
Sec; but in general, very little is taken. Gruel, toast-water, or 
lemonade, form proper drinks; and ripe fruits, are both grate- 
ful and useful. In the advanced stage, cordials, particularly 
wine, should be given prudently. 

When the fever abates, care must be taken to prevent consi- 
derable exertion, or error in diet, either of which might cause 



£ 9 



a relapse. Nothing" confirms the health, or removes the conse- 
quences of fever, so effectually, as change of residence, at least 
with the inhabitants of towns. 



SORE HEAD. 

Children, especially those not very cleanly and having a good 
appetite, are subject to a sore head, sometimes called reef, or 
felon. It often begins on the fore part of the head, in large 
white scabs, which, if neglected, spread over the head, fore- 
head and face, in large patches. In the beginning, generally it 
is dry; at other times, it is moist and has a thin discharge. — 
Medical writers have named this complaint crusta lactea, or 
milky crust, from its appearance. The children of the lower 
order of country persons, who are gross in feeding, are most 
subject to it; and it seems to be occasioned by a want of clean- 
liness and exercise, which children, who have a bountiful sup- 
ply of suck, require; but to which, parents in this situation are 
not often disposed, or seldomer have opportunity to afford them. 
A cabbage leaf is a very common application, as it promotes a 
discharge from the head, which is supposed necessary, previ- 
ous to the cure; but as such a discharge is no way necessary, 
and as it makes the head uncommonly offensive, it is better not 
to encourage it; and the sooner the complaint is cured, the bet- 
ter. For that purpose, take of brandy, and water, each equal 
parts; or one part brandy, and two of water; mix them toge- 
ther, and bathe the parts of the head and face where the com- 
plaint is, once a day, and immediately afterwards lay on a plas- 
ter of calamine cerate (commonly called Turner's cerate) spread 
upon a linen rag, which is also to be renewed every day, after 
each washing with the brandy and water. Two or three doses 
of physic must be given during the cure. Bathing in the sea, 
will be of great use. (Try the salt bath.) I have met with no 
cases which were not readily cured by these means, and with 
perfect safety to the child. If the child be purged, no inconve- 
nience can attend the early removal of the complaint, as I am 
fully satisfied of, by repeated experience. 



S70 

A child is liable to have this complaint in the first or second 
month, or afterward; it is uneasy to the child, and very disa- 
greeable and offensive to the sight and smell. The applications 
must be continued while any remains of the disorder can be 
discerned- 

SCALD HEAD. 

Children of about four or more years of age, are very liable 
to sore heads, that differ from the preceding; as the soreness is 
confined altogether to the head, except that it will extend to 
the neck if neglected. It begins in distinct brownish spots, 
that form a scab and discharge a thick, gluey matter, that 
sticks amongst the hair. The spots increase and enlarge so as 
to cover a great part of the head. When these spots are dis- 
covered, the hair upon and about them must be cut as close as 
possible, and they must be washed well, every day once or 
twice, with soap and water. Should that not prove sufficient 
to remove them, they may be daily anointed with a little tar 
ointment, or Barbadoes tar, with the point of the finger; which 
rarely fails of a cure. The scald head, which is either this 
complaint in the extreme or nearly allied to it, may be treated 
in the same manner; and which will be going as far can with 
propriety be attempted by females, 



THE MEASLES. 

The measles, like the small-pox, do not often attack young 
children, who will frequently escape, although the disease be 
in the same house with them. The measles prevail most in 
the spring season. 

The signs, or symptoms of the measles, are a sickness; a hea- 
viness; a thirst; a short, dry, husky cough, with hoarseness; a 
sneezing, and running at the nose; and a running and thin dis- 
charge from the eyes, which appear red and much inflamed, 
particularly the eye-lids; sometimes cold shiverings. These 
symptoms are commonly slight at first, and increase till the 



71 



measles come out; which generally happens on the fourth day 
from the first attack, although children will frequently be much 
indisposed for a week before they come out. At the first ap- 
pearance of the measles, they look like flea bites upon the face 
and neck, in distant spots; but, soon after, the face, neck, and 
breast, are covered in patches, resembling a thick rash that 
does not seem to rise above the skin, although it may be disco- 
vered by the touch and feel of the hand, to be a little promi- 
nent or raised upon the face and breast, but not upon the other 
parts of the body. The measles, like the small-pox, come out 
first upon the upper parts of the body, and last of all upon the 
feet; and they observe the same progressive regularity in go- 
ing off, 

There is no disease to which children are liable, that is so 
sickly, and attended with so much depression and dejection, as 
this; as it is very common for the most lively children to lay in 
a stupor, or state of heaviness and seeming insensibility, from 
the second day of the attack, during the whole of the com- 
plaint, which continues three days after the first coming out: 
on the third day, the eruption begins to look paler; and, on the 
fourth, goes off with a mealy appearance upon the skin. Dur- 
ing the whole of the complaint, there is a smart fever, which 
often, with the cough, and a difficulty of breathing, increase in 
proportion as the disorder advances, and will sometimes be the 
most violent and severe at the height, or turn of the measles: 
sometimes the fever, cough, and other symptoms, abate: and 
the child recovers, in part, his spirits soon after the measles 
come out; but this is not often the case. 

A child in this complaint, must not be kept either very warm 
or very cold : it ought not to be kept near the fire, nor yet suf- 
fered to breathe the cold air : it will be best to confine it to 
one room that is moderately and temperately warm ; cold air 
will add to its hoarseness, and make the cough worse. Its 
drink may be water, barley water, milk and water, balm tea, or 
any weak liquor; but water, or milk and water, seems most 
agreeable to children at this time. What it drinks ought to 
be a little warmed, but not hot. Wine, and cordials, in all 
shapes, must be totally avoided. 



73 



These are the most material precautions which are to be ob- 
served on the first attack of the measles; and although it is not 
always thought necessary to have recourse to medicine, it may 
frequently be employed to great advantage. It will always be 
proper to give something at the beginning, to procure two or 
three loose stools; as the infusion of senna, salts, oil, prunes, 
or manna; rhubarb, in any shape, is not very proper. Bleeding^ 
with leeches, or with the lancet, has been thought necessary, 
particularly when the cough is severe and violent; but it ought 
to be very cautiously ventured upon. 

Blisters, applied between the shoulders or to the sides, have 
been found of great use in abating the cough and relieving the 
breathing, and may safely be applied at any period of the dis- 
ease, if the cough and breathing be bad. Cupping the sides 
and back, will be equally efficacious. 

A fever always accompanies the measles, and is the cause of 
the drowsiness and stupor which children have in the begin- 
ning, and often during the whole of the complaint. Nothing 
will so sensibly check and abate this fever, remove the drowsi- 
ness, and restore a child's spirits, as repeated doses of the anti- 
monial puke; it may be begun with on the second or third day 
after the sickening of the child, and after the stools have been 
procured as above directed, and repeated, once a day at least, 
while the fever and heaviness continue; it will be particularly 
proper to give it in the evening, at which time the fever is com- 
monly most severe; and if it operates, as it generally does, both 
by vomit and stool, it will give most sensible relief; the fever, 
heat, and oppression, will be considerably abated; and the child 
will be much more easy and cheerful, and more tranquil and 
composed, than before taking it. 

The fever and cough will very frequently continue, without 
much abatement, for a few days, or a week, after the measles 
are entirely gone; but which may be greatly relieved, or entire- 
ly removed, by opening physic; a dose of which may be given 
as soon as the measles are turned: and repeated once, or twice, 
in the course of a week. The stools are generally very offen- 
sive and the matter of which they are composed is, whilst re- 
tained in the bowels, sufficient cause for the fever; and it may 



373 

reasonably be supposed to be the cause, when the relief that is 
obtained by the discharge of it, is considered; as the fever is 
sensibly subdued by the operation of the physic; and it is on this 
account that repeated doses of physic are found so requisite 
after the measles. It may always be known that the fever 
continues, while the dulness, thirst, and want of appetite remain; 
and, during which time, the physic ought to be given, at proper 
intervals, if no other cause forbids it. It may also as certainly 
be known that the fever is gone off, when the child's spirits an4 
appetite return; and when they do return, the physic may be 
discontinued. The danger from the measles is much increased 
when they happen to be connected with the small-pox or hoop- 
ing-cough; and therefore, so circumstanced, they require more 
medical attention than is generally bestowed upon them. 

The eyes, and particularly the eye-lids, will sometimes re- 
main sore, swelled, and inflamed after the measles. The cough 
also, will oftentimes continue for some time after the fever and 
every other remains of the measles are gone. While either of 
these complaints of the eyes, or the cough remain, the child 
ought not to be suffered to go out of doors, or be exposed to 
the cold; as the air, of a cold season particularly, is very apt to 
add to and greatly aggravate these complaints, and may make 
them very troublesome and tedious. Too much caution, there- 
fore, in avoiding cold, cannot be observed, while there is any 
remains of sore eyes, or cough. The measles sometimes leave 
these symptoms for the remainder of life: which most fre- 
quently may be attributed to a too early venturing out, which 
of course would have been prevented by seasonable confinement 
withindoors. When these complaints are of long standing, 
their cure is difficult and tedious. A warm climate, issues, 
blisters behind the ears and back of the neck, and living on a 
low diet, tend most to afford relief. The blisters are to be 
allowed to heal, and then renewed, in preference to keeping 
them constantly discharging. Nor is there the slightest doubt, 
but that cupping the same parts will frequently prove ser- 
viceable. 



Ii 



274 



OF WORMS. 

Worms of different kinds, are found in the bowels; but there 
are chiefly two, met with in children, the lumbricus, or long 
worm, having a general resemblance to the common earth 
worm, and the ascaris, or small white worm, like a bit of 
thread. These two kinds inhabit different parts of the bowels, 
the small worms being confined to the under part, or straight 
gut, whilst the other is found much higher. It is extremely 
difficult to account for the production of worms, as they are 
generally different from those found in the earth, or on vegeta- 
bles. It is evident that they cannot be of external origin; but 
how they come to exist in the bowels of a child, is a very diffi- 
cult question to answer. It l>as been popularly supposed, that 
particular kinds of food, or sweat-meats, or unripe fruit, breed 
worms; but this is only true, in so far as these disorder the sto- 
mach and bowels, and weaken their action; for worms rarely 
appear, when the action of the bowels is vigorous. It is also 
observable, that few infants have worms, till after they are 
weaned, which is to be accounted for on the principle, that the 
bowels are in better order during suckling, than afterwards, 
when the diet is more varied and indigestible. 

Worms may exist without producing any symptom, until 
they either accumulate in considerable quantity, when they 
cause more or less irritation in the bowels, or some slight in- 
disposition takes place, and they, by their irritation, increase 
it. All the injury they produce, is that of irritation: but the 
degree of this, and the effects of it, must vary, not merely ac- 
cording to the number of worms, and their movements, but also 
according to the state of the bowels themselves. It is also to 
be remembered, that as a weakened state of the bowels is fa- 
vourable for the accumulation of worms, many of the symptoms 
may proceed from that state alone, independent of the new 
irritation. 

The long worms may be suspected to exist, when the child 
complains of frequent griping, or pain in the belly, has repeat- 
ed and unexpected attacks of looseness, variable appetite, bo 



275 

ing sometimes seized suddenly with extreme hunger, has swel- 
ling of the belly, especially at night, disturbed sleep, frightful 
dreams, and grinding of the teeth. Besides these symptoms, 
we also observe, that the countenance is alternately pale and 
flushed; the child picks its nose, has fetid breath, dry cough, 
and sometimes slow fever, or convulsive affections. These 
symptoms may exist in different degrees, and are ultimately at- 
tended with the expulsion of worms, either by vomiting or 
stool. It has been supposed that a very obstinate and protract- 
ed fever, called worm fever, might also be produced: but this 
generally depends more upon costiveness, or a deranged state 
of the bowels, than simply upon worms. It resembles a most 
formidable disease, the water in the head* 

A variety of worm medicines have been employed, such as 
tin powder, tansey, sulphur, hellebore, worm seed, cowage, In- 
dian pink root, Sec. In general, however, we find, that with 
children, the most successful plan is to give frequent and re- 
peated purgatives, to expel both the worms and morbid stools, 
and also to excite and support the due and vigorous action of 
the bowels. For this purpose, the occasional use of a suitable 
dose of calomel, and the regular employment, on the interme- 
diate days, of aloetic pills, if the child can swallow them, will 
be effectual. The extent to which this plan is to be carried, 
and the period for which it must be continued, will depend on 
the effects produced. As long as the stools are foetid and un- 
natural, the purging should be copious, and be continued. 

In cases of a third species of worms, called taenia, it is some- 
times difficult to cause the expulsion. It is most common to 
adults. Besides the common powerful medicines for adults, 
large doses of the spirit of turpentine have been recommended, 
(taken in milk,) on an empty stomach in the morning. The 
dose to be from two to three table spoonfuls, for the robust. 

A decoction of tobacco, applied to the stomach, has often 
caused the expulsion of worms, when other remedies failed.—- 
But I never knew a case of failure when the patient Was freely 
purged with calomel, and then given either the worm-seed oil, 
agreeably to the directions on the phials in which it is sold, or 
the Indian pink mot in tea. The oil should be given on an 



276 

empty stomach iti the morning; or the tea taken occasionally 
throughout the day, in doses to suit the age of the patient. — 
About ten grains of the powder may be given to a child of 
eight or ten years old, two or three times a day. When in over 
doses, it is apt to affect the head, and the quantity is to be les- 
sened. 

The generation of worms may be prevented by whatever 
will strengthen the bowels. A good, healthy diet, a little pure 
wine, the ordinary tonics, rust of iron, bark, or bitters, may be 
fried. 



SUMMER COMPLAINT, CALLED CHOLERA INFANTUM. 

This is a disease which carries off, annually, thousands of 
the children of this country, particularly of the towns. It ge- 
nerally appears in June, a few days after the hot weather com- 
mences. It is a fever arising from the heat and change brought 
on in the atmosphere by the season, attended with obstruction 
in the liver, which causes the copious secretions in the sto- 
mach and bowels. The matter thrown up from the stomach, 
and discharged from the bowels, varies in almost every case. 

It is to be prevented, by carrying the children to the country 
in the beginning of the season; by riding them out every morn- 
ing before the heat of the day is considerable; and by keeping 
them in the coolest part of the house. One of the best institu- 
tions for our summers, productive of incalculable good to this 
country, would be the establishment, in our towns, of waggons 
or carts, to take all the poor children about a mile into the 
country every morning; and whether to remain there or not un- 
til night, in all probability, the bowel complaint would be effec- 
tually prevented, and their constitutions effectually strengthen- 
ed. I have long been so deeply impressed with the vast impor- 
tance of this daily exercise for children, especially in the begin- 
ning of hot weather, that when unable to procure a carriage, 
for my children to make an excursion in the country every 
day, I have substituted any kind of vehicle which could be 
procured. 



%Y7 

The cure, when the disease has appeared, may be commenced 
by the mother, in giving the child five grains of calomel; the 
purging of which to be promoted by giving fresh meat tea.— 
The disease is often kept up by the irritating, offensive matter 
in the bowels; and therefore the bowels are to be kept open by 
active medicines, until the high action subsides. There should 
be given daily, every two or three hours, about a quarter of a 
tea spoonful of prepared chalk, (which is common chalk pow- 
dered and washed well,) for the purpose of correcting the offen- 
sive nature of the contents of the bowels. A little salt of tar- 
tar, or ley, will answer; also finely powdered charcoal, or crust 
of bread burnt black, either taken in a little milk. A most im- 
portant remedy, which ought to be resorted to in every in- 
stance, is cupping the right side, opposite the liver. It had 
better be after the skin is a little scarified, or cut skin deep 
with a sharp lancet; if not, dry cupping will do some good. — 
This cupping may be extended to every part of the body, espe- 
cially the lower extremities; it is for the purpose of drawing off 
the blood from the interior, and should be daily tried in every 
case. After a second purge is given to the child on the second 
day, if the lax continue, one grain of calomel with one drop of 
laudanum, should be given twice a day, for three or four days: 
in these cases, the calomel will not be apt to salivate. The 
child should not be removed until recovery, as rest is very im- 
portant. Should the disease have continued for some time, 
apply brandy on the belly. The tincture of Spanish flies, or a 
blister applied for an hour or two, to redden the skin of the 
belly, on the wrists, and on the legs, will be of great service.-— 
The child should be removed to the country as soon as its dis- 
ease subsides. After the febrile action is reduced, a little lau- 
danum may be given to lessen the relaxed state of the bowels. 
The diet should be of the best kind. By such treatment, occa- 
sionally aided by the warm bath in the beginning, children may 
generally be cured; but I would always recommend the employ- 
ment of a physician, if the first dose of calomel, with cupping, 
should not relieve. 



278 



HOOPING COUGH. 

There is no disease more generally treated improperly by 
parents, than the hooping-cough. In the beginning, it is al- 
ways an inflammatory complaint, requiring evacuations and de- 
termination of blood to the surface of the body. Instead of the 
variety of prescriptions in daily use, give the child an emetic, 
to be repeated every day or other day, unless the symptoms les- 
sen. For a violent fit of coughing, the best remedy is, to pour 
in the back of the mouth a tea spoonful of melted hog's lard, 
which sheathes the part, and lessens the irritation. The tinc- 
ture of asafoetida is highly recommended. I have known relief 
to be obtained by holding a strong tea of the Jamestown weed 
in the mouth for a little time, taking care not to swallow it.— ■ 
A child grown enough for the purpose, will find some relief in 
holding very hot water in the back of the throat. It is of great 
importance to children in this complaint, to keep the skin in 
good state. A coarse flannel shirt, in some cases; in others, a 
very rough piece of oznaburg around the breast, have been of 
great service, by keeping up friction on the surface. With the 
flesh brush, or a ball of wool, the surface of the body should 
every night be rubbed. Exercise in open air, while the body 
is kept comfortable, is immensely salutary, as well as change 
of residence for a few weeks, which scarcely ever fails to afford 
relief. The juice of garlic sweetened, lessens the cough. A 
solution of soda, also of potash, in doses of three or four grains, 
and sweetened with liquorice, is a valuable remedy. Twenty 
grains of tartar emetic and an ounce of the tincture of Spanish 
flies, nightly rubbed on the stomach, is a remedy highly ex» 
tolled. 

OF THE CROUP. 

The treatment of this disease, ought to be understood by eve- 
ry mother. It is known by a singular, hoarse, hollow kind of 
breathing, and by symptoms approaching to suffocation. — 
Those living in rooms warmed by stoves, are most subject to 



ADDRESS V. 



TREATMENT OF DISEASES. 



WHICH 



REQUIRE IMMEDIATE ATTENTION. 

In general treatises on diseases, it is customary to make some 
sort of classification. But I know of no two authors, who, on 
this subject agree in their arrangements: nor indeed of any 
classification to which strong objections may not be very justly 
made. Diseases are so interwoven with each other, the shades 
of difference so imperceptible; that it seems impossible to do it 
with any thing like tolerable satisfaction. On this account, I 
adopt no system: but indiscriminately select such affections as 
present themselves to me in the order of the importance of their 
being most generally understood, as much on account of their 
frequency as of their danger. And first, I will make some re- 
marks on common 

FEVER. 

There is no disease so general, so imperfectly understood, 
and so frequently fatal, as the various fevers to which we are 
subject. Proteous like, it shows itself in so many ways, in such 
strange variety of form, that, as Dr. Thomas observes, "it is 
impossible to give a concise and proper definition of the dis- 
ease known by the name of fever.'' 

In general, we judge of the presence of fever by irregulari- 
ties or changes from the natural state of the pulse and of the 
skin; the colour of the face, the eyes, the tongue; the breathing, 
the appetite, the state of the stomach and bowels; the sensa- 
Kk 



383 

tions of pain, of strength, and of disposition to sleep. Some- 
times all these exhibit disease; but sometimes the most remark- 
able or conspicuous appear healthy, although great danger may 
exist. The subject, to be well understood, requires a most mi- 
nute and diligent investigation. But for our common fevers, 
enough is known, and may be easily understood, to lessen their 
great ravages. 

The ancients supposed fever to arise from the efforts of the 
system to expel morbid matter in the body. But this doctrine, 
long since, has been found to be erroneous. Their successors 
supposed it to be the effort of a spirit of life (vis medicatrix 
naturae) to overcome the constrictions or spasms of the small 
vessels. Again, it has been contended that it altogether de- 
pended on the nervous system. The famous Dr. Brown main- 
tained that it arose from stimulants, either in excess or defici- 
ency, producing too much or too little action or excitement in 
the blood vessels. Our countryman, Dr Rush, taught that 
there was but one disease — and thas was irregular, morbid, or 
convulsive action in the blood vessels. Professor Chapman, of 
Philadelphia, considers most diseases as originating in the 
stomach. 

I take a very different view of the subject: one that is obvi- 
ously to my mind, more an induction from facts. In the sketch 
of the composition, formation, or make of the human body, I 
stated that it is made of three distinct systems or vessels — the 
nervous, for supplying the animating capacity; the sangrifer- 
ous, or blood vessels, by which the secretions of the body are 
formed; and the absorbent vessels, or consuming system, by 
which all parts of the body are perpetually taken up and car- 
ried again to the blood and its vessels, to undergo a sort of re- 
manufacture. Now, these systems are, in their animal relation 
and mechanical construction, so interwoven, that it is impossi- 
ble to separate them; and it is equally impossible to affect one, 
without more or less affecting the other. The first physicians, 
from their partial views, would naturally be struck with the 
most conspicuous result of fever — the fluids of the body. — 
Their successors, seeing the error, would equally naturally be 
impressed with the effects on the sensorial power, and ascribe 



S8S 

all to it: and in like manner, when this error was detected, Dr. 
Brown and his successors were, and are still, for attributing all 
to the more or less or irregular action of the blood-vessels. 

A deliberate view of this subject — made without reference to 
what first strikes our senses, will satisfy any impartial, unbias- 
sed observer, that the absorbent or consuming system is secon- 
dary to neither of the others in power, in activity, and in its 
agency in producing disease in itself, the nervous, and blood- 
vessels. Its power is immense: for in one night, it has been 
known to take up gallons of water from the belly and other 
parts in which it had been diffused during dropsy, and then 
depositing it in the blood vessels, force them to disgorge or 
evacuate it. Its activity is shewn by the above fact, as well as 
its constantly taking up the whole substance of the body: its 
agency in producing disease; by being excited into unnatural 
action, taking up such large portions of the body as to enfeeble 
and emaciate it, pouring it so continually in the blood-vessels 
as to keep them full and in high action during continued fever. 

These effects establish that the absorbent system is one of 
the great causes of the continuance of fever, in constantly sup- 
plying the blood-vessels with an undue portion of material for 
blood, thereby keeping up their irregular action, and therefore 
calling for the profuse evacuations we are obliged to make in 
fever of high action, although no food be taken for weeks. 

Heretofore, in the treatment of fever, attention has been con- 
fined chiefly to the nervous and blood vessels: but a more ex- 
tended view would embrace the absorbents. We can rouse 
these to action, but know not how to arrest it. The man who 
may hereafter discover the most effectual mode, will, in my 
opinion, rank among the greatest discoverers in medicine. 

When the action of the heart and arteries is accelerated-Htio 
matter from what cause that it is continued, or through 
which of the three systems we have named,— -it is followed by 
more or less interruption in the circulation of blood through 
the liver. You should remember that the circulation of blood 
through this ortran, is carried on by veins, which are always 
slower in their motion than the arteries: and you should also 
remember that these veins come from all those parts engaged 



284 

in the digestion of our food, and formation of our chyle for 
blood, called the chylofioctic parts, or viscera. Now, it follows, 
therefore, as a necessary consequence, that any accumulation of 
blood in the liver, any kind of obstruction, must unavoidably 
cause the blood to fall back on the stomach, bowels, and other 
of the important parts concerned in making the chyle. The 
stomach sometimes has been thought to be the seat of the soul, 
so intimately is it connected with all parts of the system, or so 
much do all parts sympathise with it. Hence, although it may 
unquestionably (as all other parts) have original disease, there 
is no doubt but that the greater number of its affections, and of 
course other parts connected with it, arise from the liver, in- 
stead of the stomach, as maintained by Dr. Chapman. 

In the treatment of fevers, it is of the utmost importance 
that you should constantly keep this view of the subject in your 
minds. It shews fully the necessity of two things: the first is, 
of free purging, to empty the vessels of the bowels, so as to 
prevent the blood from too long stagnating in them; and, the 
bowels of their contents. — The other main object, is to draw 
the blood from the interior, so that there shall be action on the 
surface, to relieve the engorged or stuffed vessels of the interi- 
or. Hence the great object in the treatment of fevers is, ac- 
cording to Dr. Rush's doctrine, to equalise action. But this is 
to be done much according to the principles of Dr. Brown — in 
reducing or increasing excitement, according to the high or 
low state of the body, and we are necessarily obliged to attend 
to the state of the stomach, according to Dr. Chapman, as it is 
one of the chief mediums through which we are to operate on 
the whole body. According to my particular views of this sub- 
ject, these theorists pay too exclusive an attention to the action 
of the vessels. Surely this action is of primary importance; 
and so is the state, condition, or construction of the vessels, as ex- 
plained by me on the subject of secretion. Sometimes it is im- 
possible to decide when the system is in a critical state, whe- 
ther it be bordering too much on the high or low action; whether 
we should add to or take from its excitement. Here, then, ac- 
cording to my views, we have to change the state of the solids 
of particular parts, so that they may revert to their natural con- 



285 

dition with all those which sympathise or are particularly con- 
nected with the part on which we operate. 

Fevers are supposed to terminate particularly on certain days 
called critical days. But I do not believe there is any ground 
for such distinction. The days on which they are supposed 
to end, are the third, fifth, seventh, ninth, eleventh, fourteenth, 
seventeenth, and twentieth. 

Candour induces me to state the fact, that it is very doubt- 
ful whether the mode of treating fever has been materially im- 
proved since the days of the first medical writer, Hippocrates. 
Notwithstanding the great variety of theories, the practice has 
been pretty much the same in all ages — to evacuate in an inflam- 
matory state of the system, and to stimulate in cases of low ac- 
tion. And if there be an improvement in the treatment of com- 
mon fever, I think it is in the use of antimonial medicines. — 
Their operation is not understood; but they certainly tend to 
lessen or subdue diseased action in the blood-vessels. The 
best form of their administration, is in small doses of tartar 
emetic, continued at short intervals so as to keep up a constant 
sickness of stomach, with its usual attendant, a state of perspi- 
ration on the surface of the body. 

When the action of the blood-vessels is considerable, bleed- 
ing is indispensably necessary. Free purging with the most 
active of the medicines of this kind, is generally called for; and 
these evacuations are to be regulated by the state of the patient, 
the degree of his diseased action. 

In every case of high fever, I would not only recommend con- 
stant evacuations from the bowels: but the purification of their 
contents by repeated doses of prepared chalk, of the salt of tar- 
tar, or charcoal in powder, and of yeast, with a little of the dust 
of charcoal in it. This is more particularly necessary in fevers 
called nervous or of low action, where the contents of the bow- 
els seem in a stagnant state and very much tending to putrefac- 
tion. In such cases, stimulants, laxatives, washing with cold 
water, and blisters, constitute the proper remedies. 

Fevers may be considered as of two kinds— original and 
symptomatic, or arising from some local affection; as, for ex- 
ample, the fevers arising from wounds, from inflammation of 



286 

particular parts: as the lungs in pleurisy, the bowels, kidneys, 
&c , which will be treated of under their particular heads. 

Original fevers may be divided into three distinct states. — 
The first, of a violent kind: the second, of an intermediate state: 
and the last, of a low, nervous, malignant character; — each of 
which states may arise in the same person during one attack. 

Dr. Rush enumerates the following causes of fever: — I. Ex- 
halations from marshes. 2. Putridity of Cabbages. 3. Pota- 
toes. 4. Pepper. 5 Indian meal. 6. Onions. 7. Mint. 8. 
Anise and carraway seeds. 9. Coffee. 10. Chocolate shells. 
11. Cotton. 12. Hemp, Flax, and straw. 13. The canvass of 
an old tent. 14. Old books and papers that had been wet. 15. 
The timber of an old house. 16. Green wood, confined in a 
close cellar. 17. Green timber of a new ship. 18. The stag- 
nant air of a ship. 19. Bilge water. 20. Water long confined 
in casks at sea. 21. Stagnant rain water. 22. The stagnant 
air of close cellars, 23. The matters usually stagnant in gut- 
ters, confined streets, and sinks of kitchens. 24. The air emit- 
ted by agitating stagnant water. 25. A duck pond. 26. A 
hog stye. 27. Weeds cut down and exposed to heat and mois- 
ture near a house. 

He also states fevers to arise from — 1. Human bodies unbu- 
ried. 2. Salted beef and pork. 3. Locusts. 4. Raw hides 
confined. 5. A whale putrefying on shore. 6. A large bed of 
oysters. 7. The entrails of fish. 8. Privies. 

The usual forms of disease arising from these sources, are, 

1. Malignant or yellow bilious fever. 

2. Inflammatory bilious or remittant fever. 

3. Intermittent fever.-^All occasionally degenerating, the one 
into another, and into the lowest or nervous fever. 

You must surely perceive, under these circumstances, that it 
is actually impossible to give particular directions for the treat- 
ment of original fever. To attempt it, would be an imposition. 
And I feel more than you do, the defect on this subject in the 
healing art. 



287 

But suffer me to impress on you anew the general directions 
Learn the particular nature of the prevailing disease. In ca- 
ses where the pulse is full or hard, resort to free bleeding and 
large doses of calomel, united to small doses of emetic tartar. 
After proper evacuations, let blisters be applied to parts oppo- 
site, where there seems much internal affection. When the 
heat of the body is considerable, sponge it, or rub it over with 
a cloth dipped in cold water, or vinegar and water. Never 
suffer the contents of the bowels to be stagnant, and correct 
their offensive state by prepared chalk or charcoal. Let the 
drinks and diet be of the mildest kind, such as are commonly 
called cooling. When the violent symptoms subside, let your 
dependence be most on antimonials, of which you will find a 
good form under the head of Dr. Rush's nitrous powders.-— 
When the disease is of a low, nervous kind, resort to the ordi- 
nary stimulants of wine, toddy and fermented drinks; to prepar- 
ed chalk, yeast, and charcoal; to cold bathing, when the skin 
is hot; to a generous diet of gelatinous soups; to blisters; to 
dry cupping over the liver and back of the head; to great clean- 
liness; fresh, pure air; to the best of nursing, especially when 
the disease is subsiding. Besides the stimulants above stated, 
camphorated julep and musk have been recommended; I have 
frequently prescribed them, in obedience to custom: but, with 
Professor Hosack, of New York, I can truly say, never with 
any benefit. The most common stimulants are always the 
best, and most readily procured. 

It would be easy to add here, the signs of recovery and death 
in fevers. But I will make one correct remark, often made by 
others, that there has not been discovered one symptom which 
has not been the frequent forerunner of amendment, or fatal 
issue. The only certain sign of death, is the commencement 
of putrefaction. 



288 



EPIDEMICS. 

Diseases prevailing generally in one place at the same time, 
are usually called epidemics. They vary in most seasons and 
situations. 

There is one important law respecting epidemics, that should 
always be remembered. It is, that each of them makes all dis- 
eases assume its own livery, or character. And as, probably, 
no too epidemics are precisely alike, the only rational advice 
which can be given on the subject, is to study or learn the par- 
ticular nature of each when it occurs. This is incumbent on 
all to do: as during the prevalence of general diseases, it is im- 
possible to procure the aid of physicians in most cases, as well 
from their excessive business as their own liability to the pre- 
vailing disease. In the well known yellow fever in Phila- 
delphia, in 1793, Dr. Rush thought it incumbent to publish 
his successful mode of treating the disease: and it was the cause 
of many hundreds prescribing for and saving themselves, fami- 
ly and friends. A similar course should be pursued, I think, 
by all physicians, when a new epidemic commences. 



AGUE AND FEVER. 

This disease is one of our most common epidemics. It most 
commonly prevails in the fall, and near low lands, marshes, and 
on the water courses of our rivers. The disease occurs at stat- 
ed and very various intervals — either daily, or every second, 
third or fourth day. 

A well marked case or fit of ague and fever, is generally di- 
vided by writers, into three stages: — the cold, the hot, and the 
sweating, and is thus described. — The cold stage commences 
with a sense of languor, of weakness, and aversion to motion 
and to food, with frequent yawning and stretching. The face 
and extremities become pale; the features shrink, as do all parts 
of the body; the skin appears constricted, as if it had been 



289 

exposed to cold* At length, the patient feels very cold, and 
universal shaking comes on: breething is small, frequent, and 
anxious; the urine is almost colourless: sensibility is impaired; 
the pulse is small, frequent, and sometimes irregular. 

These symptoms abating after a short time, the second stage 
commences with an increase of heat over the whole body, red- 
ness of the face, dryness of the skin, thirst, pain in the head, 
throbbing in the temple, anxiety, and restlessness: the breath- 
ing becomes more full and free, but still frequent: the tongue 
is furred, and the pulse becomes regular, hard and full: in ca- 
ses of great severity, delirium is apt to occur. 

These symptoms having continued for some time, a moisture 
breaks out on the forehead, and by degrees becomes a sweat, 
which gradually extends over the whole body. As this con- 
tinues to flow, the heat of the body abates, the thirst ceases, 
the urine deposites a sediment; respiration is free and full, and 
most of the functions are restored to their ordinary state; the 
patient, however, being left in a state of weakness proportion- 
ate to the violence of the preceding attack. 

Although this be the common description of a common fit of 
the ague and fever, it is subject to great variations in every 
stage: depending on as great variety in causes and peculiarity 
of constitutions. The treatment, whether the disease recurs 
every day or otherwise, is the same. Our object is to shorten 
the duration of the fit when it comes on, and to prevent its 
recurrence. 

The treatment when the fit comes on, is, in the cold stage, to 
take any weak drink as hot as possible; to apply hot applica- 
tions to the feet; and, to lessen the shaking, it is of service to 
grasp the limbs very tight, or to apply tight bandages around 
them, to compress the muscles. When this stage subsides, 
the drinks should be continued, and a very weak solution of 
emetic tartar and wine should be given hourly, to favour the 
sweating. If the symptoms run alarmingly highly, as is some- 
times the case, moderate bleeding is proper, and cooling drinks 
of water and vegetable acids. During the sweating stage, the 
patient should not be kept very warm, nor exposed to such a 
current of air as might endanger the sudden suppression of the 
LI 



290 

sweat. When this ceases, he should be wiped dry, have his 
clothes changed, and take a little nourishing food. 

The duration of the fit has sometimes been lessened by a 
vomit at its commencement — also by a dose of laudanum, pro- 
portionate to the strength of the patient. In proportion to the 
apprehension of its violence, should be the vigilance of the at- 
tention to expedite its termination. A tight band or cord 
around the arm and thigh of opposite sides of the body, has 
been highly recommended; and I have successfully applied ban- 
dages, extending from the fingers to the shoulder, and toes to 
the hip — having previously bathed the part in spirit, or in the 
tincture of Spanish flies or red pepper. 

But our great object is to prevent the recurrence of the fit in 
any degree: and for this, we must REVOLUTIONIZE the 
whole body. Generally the best practice for this, is first to 
give a large dose of jalap and calomel, or of any other purga- 
tive which will operate powerfully, to be taken at night. The 
next morning, a vomit should be given: but it is not material 
whether the vomit precede or follow the purge. The opera- 
tion being over, the common Peruvian bark in substance, or 
our astringent oak, dog-wood, poplar, and wild cherry tree 
barks, should be given in broken doses. The patient may make 
his selection of the articles classed under the head of tonics.* 
always changing them, and never talking any while he has got 
a fever. 

I have had much practice in this fever, in some of the most 
obstinate cases, and with persons who have had it for more than 
two years: and have never, in any instance, failed putting a spee- 
dy end to the disease, by the use of the salt bath, followed by 
some common bitter, or~oTdinary tonic or strengthening medi- 
cine. A quart or half a gallon of cold, strong brine, is to be 
poured on the naked patient, early in the morning; when he is 
to be wiped dry, and return to bed for thirty or forty minutes, 
when he may rise and breakfast. Exercise, particularly before 
the expected return of the ague, should be freely taken, with a 
moderate portion of bark, elixir vitriol, or any common tonic. 
Since I adopted this plan, I do not know that I have ever given 
an ounce of the Peruvian bark. 



291 

Those who choose to take the Peruvian bark, should remem* 
ber that it is not given more to increase the strength or tone of 
the system, than it is to shock or revolutionize it. They should 
consequently not take it long: but in three or four times the 
quantity ordinarily given, about three or four hours before the 
expected attack. It is common to add some stomachic to the 
bark, of which ginger, Virginia snake root, cannella alba* wine, 
common bitters, a little laudanum, are most generally used.— • 
An ounce to a quart of hot water, constitute the infusion fre- 
quently prescribed. Sometimes the bark has been given in in- 
jections with laudanum, when the stomach would not retain it. 
Rubbing the powder of it on the skin, is a much better mode of 
using it, than the once famous bark waistcoat, made by quilting 
bark in thin cloth. The bark in a bath, is frequently used on 
weak persons of irritable stomachs. Decoctions of the barks 
of our oaks, of the dog-wood, of the wild cherry, and poplar 
trees, are of equal service, when externally applied, and more 
economical. 

Fowler's solution of arsenic, in doses of six or seven drops 
two or three times a day, is esteemed a never-failing remedy. 
A dose of the black spider's web, taken from dark places, (five 
or ten grains,) has been given with success before the coming 
on of the fever. Small doses of white vitriol, and of copperas, 
have been recommended. Powdered charcoal, in doses of two 
or three tea spoonfuls, and as many times a day, is much used 
in some countries. Sudden alarm, or very great excitement of 
the mind, have prevented the recurrence of the ague. Run* 
ning, over doses of onions, of cider, and, in short, many irregu* 
larities, have arrested the progress of this disease. It is ex- 
ceedingly apt to recur in all cases, unless the person is very 
careful to not expose himself; change his residence; use the 
shock or cold bath in the morning; wear flannel next his skin; 
keep his bowels free from costiveness; dress to suit the season, 
n&c. To conclude, I repeat, the system is to be revolutionized^ 
by purging and free vomiting; followed by the shock of the 
salt bath, and a moderate use of tonic medicines, to be frequent- 
ly varied, as one kind continued ceases to be strengthening. 



292 

The ague and fever long continued, is apt to end in conges- 
tions or enlargements of some of the contents of the belly, par- 
ticularly the spleen and liver. The skin, too, is apt to become 
of a yellowish, sallow hue, and dropsy not unfrequently follows. 
This renders it the more important to arrest this unpleasant 
disease: and should teach the necessity of freely emptying the 
bowels, and of determining to the skin by antimonials during 
the fever, and occasional blisters opposite the liver and on the 
extremities. 

For the diseases of the spleen and liver, a change of residence 
to hilly countries, is of great consequence, as well as hard rub- 
bing the skin with a brush and salt. A salivation, conducted 
slowly, will generally relieve; or, if not, a course of nitric 
acid. I have seen, or thought I saw, in enlargements of the 
spleen, (called ague cake,) evident good from wearing a broad 
belt, as tight as could be borne, around the belly, with a large 
ball of wool or cotton pressing immediately on or over the tu- 
mour made by the distended spleen. 

This disease not unfrequently, especially in warm weather, 
ends in what is called the 



BILIOUS, OR REMITTENT FEVER. 

Which is nothing more than the same fever without intermis- 
sions, though with daily remissions, or partial suspension of 
the fever, followed by something like a cold stage, coldness of 
the nose, &c. The treatment is pretty much the same as in 
the hot stage of the intermittent. When violent, blood-letting 
is requisite, and in proportion to the activity of the pulse, and 
state of the patient, must it be repeated. 

Frequent purging with calomel and jalap, is imperiously 
called for, not only to empty the bowels, but to empty their 
blood-vessels, filled with blood from the obstruction to its pas- 
sage through the liver. Small and repeated doses of tartar 
emetic, have a no less powerful tendency to relieve the inter- 
nal parts, and determine to the skin. Bathing the body, when 
much heated, in cold water, frequently is of great service. The 



293 

drinks are to be of the cooling kind, as a little cream of tartar, 
tamarind water, weak lemonade, &c. 

Pains in the head are to be relieved by applying cloths from 
cold water. Sickness of the stomach may be relieved by the 
saline mixture, made by a table spoonful of lemon juice or 
strong vinegar, added to a solution of potash, fifteen grains to 
a wine glass of water. Doses of a tea spoonful of prepared 
chalk should be given three or four times a day, to purify 
the contents of the bowels; a little charcoal, particularly if 
in half a cup of yeast, will have the same effect. It is in 
this state of fever, that the nitrous powders of Doctor Rush, to 
which I refer, are frequently administered every two or three 
hours. 

When the fever remits, it is then proper to try so to revolu- 
tionize the system, as to prevent its rising again, and to insure 
an intermission. The best mode, I think, in this state, is to 
give a vomit of tartar emetic, or ipecacuanhse, and apply blis- 
ters to the extremities, either of mustard or Spanish flies, boil- 
ed in spirit of turpentine, with a view to redden the skin. — 
Light nourishment may be taken; indeed, the appetite gratified 
with a little, only a little, of any article anxiously wished for. 
When the fever has entirely subsided, gentle tonics, as in the 
intermittent fever, are to be administered; but with greater 
care, as the system is then much enfeebled, and slight causes 
operate powerfully. The most attentive nursing-— the most 
simple nourishment, will be found as serviceable in expediting 
recovery, as the best medicines. 

A higher grade of this fever, and requiring often a similar 
treatment, is a species of the plague, commonly called 



YELLOW FEVER. 

So designated from the yellow tinge it gives to the skin. — 
This disease, though generally prevalent in cities during the 
close of summer and fall, does in reality take place, more or 
less, in all parts of the country. It is nothing more than a 
more malignant form of bilious fever, requiring a more ener- 



S94 

getic application of the remedies to subdue the diseased state 
of the system. But in this, as in most other epidemics, there 
is called for a variation of treatment: some calling for stronger 
evacuations, with the lancet and from the bowels, than others; 
depending, it would seem, on the constitution of the atmos- 
phere. It would be very easy for me to extend this article to 
any length, by quoting an hundred authors. But truth requires 
that I should state the fact, that no general directions can be 
given, different from those recommended in common fever, 
viz: bleed in high action; purge with calomel and tartar pow- 
erfully; inject a solution of ten or fifteen grains of tartar emet- 
ic into the bowels, as recommended for poisons in the stomach; 
keep the contents of the bowels free from any offensive state, 
by prepared chalk or charcoal, with or without yeast; bathe 
the body in cold water, when very hot; make a free use, and 
that daily, of cupping the side opposite the liver. Indeed, I 
would say, cup the whole body, to relieve the determination of 
blood to the stomach and bowels, from the obstruction in^ the 
liver: which will be aided by blistering, and that in the quick- 
est manner. 

Again, this fever, especially when not properly treated by 
evacuations in the beginning, is apt to degenerate into another 
state, called 



TYPHUS, NERVOUS; OR, VULGARLY, PUTRID FEVER. 

And this article, too, I could extend to any length, either for 
your amusement or my occupation. But it would yield you 
no instruction. The state of the system to which this refers, 
is one of entire depression. All the energies of life seem to be 
sinking. A tremulous motion is visible, more or less, in all the 
muscles. The skin is frequently hot — now cold, now dry, now 
covered with clammy sweats. The pulse is very feeble; yet, 
often very quick. 

The remedies are the reverse of those for the state of the sys- 
tem in high, inflammatory, or simply depressed condition.— 
Nevertheless, the local remedies are the same. The bowels 



£93 

must be kept open— and their contents pure by yeast, charcoal, 
and prepared chalk. Whenever any part seems more affected 
than another, then cup freely all around it. Small doses of an- 
timonials may still be requisite, as also washing the skin with 
cold water and with vinegar when the heat is great. The sys- 
tem is to be stimulated by generous diet, with wine, toddy, por- 
ter, and the like. Opium may be requisite, to procure rest. — 
Blisters are to be applied to the extremities, frequently to red- 
den or inflame the part, if not to blister. It is usual for physi- 
cians, in this state to give camphor, musk, ether, and the like 
medicines: but, as I have no confidence in their efficacy, I must- 
refer you to them. I believe the best dependence is on our 
common stimulants, and great cleanliness. As to the quantity 
of stimulants to be used, it must be regulated by the state of 
each patient. — They must be given regularly and occasionally 
varied.— When they increase frequency of the pulse, the dry- 
ness of the tongue, restlessness, difficulty of breathing, &c„ 
they are improper. But if they afford apparent relief, make 
the pulse slower, produce refreshing sleep, they are to be con- 
tinued. 



FEVER OF INTOXICATION. 

The free manners of our countrymen, render the effects of! 
intoxication a very constant object of attention. As all the 
writers on this subject choose to commence with a sort of mo- 
ralizing sermon, or lecture, about its destructive tendency, I 
hope you will indulge me with one or two remarks of similar 
import. 

In the first place, if you believe in the Scripture, and have 
committed any one sin, you have committed all. In the se- 
cond place, when a man is diseased, it is not your business to 
inquire how he brought it on himself, but in what manner can 
you relieve him. The good Samaratan, when he crossed the 
road to administer relief, did not stop to inquire whether the 
fellow had tumbled down from drunkenness or not. And, 
lastly, you may rely upon it, if the horrible anguish of body and 



296 

mind, arising from a convulsed, sickening- stomach, or a burst 
of reflections rushing upon conscience, cannot secure reforma 
tion, your advice will be as unavailing as fears of your anger or 
abuse. While the pitiable object pursues his propensity, it is 
our duty to mitigate the sufferings he entails as well as we can. 
We should be actors instead of preachers: and when extremes 
arrive, apply the only certain remedy — that rigid confinement, 
which is prescribed for all labouring under the like raving dis- 
order of mind and body. 

When a man is under the operation of intoxicating liquors, 
he is in a high fever, with particular disease in his stomach, 
with which his brain sympathises. The remedy is bleeding, 
if the fever be high. The free application of the coldest water 
from head to foot, is the next most powerful remedy. And, 
lastly, excite vomiting. This can be done by pushing a feather 
in the throat, or by any of the medicines which produce it. — 
The bowels being always disordered, a purge should next be 
given: the best in this state, is magnesia; any purgative will 
answer; but they will be improved by adding one or two tea 
spoonfuls of chalk, to correct the contents of the bowels. 

If the subject be young, or unused to excesses, the best treat- 
ment next day, is highly salted chicken water, or any meat tea, 
or strong coffee, or garden teas. If he be old in such practi- 
ces, the treatment should be different: a purge of calomel; if to 
be bled, let it be in the temporal arteries; and next morning, he 
should take some laudanum, or a small quantity of the drink 
he is accustomed to, in which some spice has been boiled. In 
short, he should be nursed as a man recovering from a long 
fever. It must not be forgotten, that great care should be 
taken to have their heads elevated r and a free admission of 
pure air. 

Sometimes persons unaccustomed to liquor, have drank so 
much at once, as to produce almost instantaneous prostration 
of all strength, endangering instant death. Under such cir- 
cumstances, there must be made every possible attempt to ex- 
cite vomiting. A long, oiled feather may be pushed almost 
down his throat; twenty grains of white vitriol should be gi- 
ven instantly, if it can be got. Blisters should be applied over 



297 

the stomach and feet; the person should be slightly whipt 
all over with rods, to excite irritation on the skin; and a physi- 
cian should be sent for, either to introduce a tube and pump 
out the stomach, or to inject a little tartar emetic into the veins, 
which has been known to excite vomiting when other means 
failed. Twenty or thirty grains of tartar emetic, in half a pint 
of water, injected into the bowels, has proved of great service. 
Should the patient recover from this stage, his life can only be 
preserved, in that succeeding, by moderate stimulation, for 
which laudanum and paregoric will be found equal to any, if 
not the best. His bowels are also to be cleansed or purged; and 
calomel is the best stimulant for the purpose, with chalk or 
salt of tartar. 

There are other immediate effects following intemperance, 
requiring prompt attention. The first is the irritability of the 
stomach, which is often such as to reject almost every article, 
often threatening instant death. To recover the capacity of 
this, any and all of the various articles called condiments, 
spices, or stomachics, may be tried; milk and lime water, fre- 
quently succeed. High seasoned soup and jellies, injections 
of laudanum, a blister over the stomach of mustard and vine- 
gar, harsh friction on the skin, the warm bath and hot ap- 
plications to the pit of the stomach, are proper. Spirit of 
camphor will sometimes compose it — so may a little of elixir 
vitriol. Cold drinks are always injurious in this state, how- 
ever great be the thirst. 

The second effect is a strong tendency to general convul- 
sions: Trembling of every part, especially the hands and arms. 
In this state, I would give a large dose of calomel and lauda- 
num : The limbs are to be roughly rubbed until they are red- 
dened : Hot salt rubbed on the skin — cupping down the back 
bone — exercise as much as possible. Sometimes a vomit has 
relieved the system in this state. A large dose of calomel 
should never be omitted : Prepared chalk or charcoal will cor- 
rect the filthy state of the contents of the bowels. The perma- 
nent diseases brought on by intemperance will be treated of 
under proper heads. 

Mm 



298 



FAINTING FITS. 

These sometimes come on suddenly, without any visible 
warning; and at others, they are preceded by sickness at sto- 
mach — some oppression in breathing — paleness of face. They 
are characterised by an entire suspension of all the animal pow- 
ers ; which continuing for a short time, they become gradually 
restored. 

In rousing the system to action, we are first freely to admit 
fresh air, and exclude all unnecessary attendants. Cold water 
or vinegar should be sprinkled on the face : strong smelling 
articles should be applied to the nose — as volatile salts, ether, 
assafoetida, burnt feathers, and snuff of a candle. A little 
wine or spirit should be poured into the mouth, and the extre- 
mities rubbed with a coarse brush. 

After fainting from excessive evacuations, cordials and sti- 
mulating diets should be often given. The patient should be 
laid down and kept at perfect rest : with hot applications to 
the breast and extremities. 

But, you should remember, that when the fainting arises 
from a great loss of blood, it ought not to be stopped sudden- 
ly : because during such fainting; the blood coagulates and the 
vessels contract — thereby tending to prevent the continuance 
of the bleeding. 

Persons liable to fainting, or indeed to any kind of fits, cannot 
be too cautious in avoiding what they have found tending to 
produce them; they should never be alone : because of the dan- 
ger of falling so that respiration cannot be renewed, and conse- 
quently ending in death, when others are not at hand to change 
the position of the body. 

In general, persons subject to fits, who are of a weakly, deli- 
cate nature, will find relief by leading a more energetic life, oc- 
casionally using some of the strengthening medicines, men- 
tioned under the head of Tonics. 



299 



APOPLECTIC FITS. 

These are marked by a sudden diminution of all the senses, 
and the patient falls down. The heart and arteries — unlike 
in fainting, continue to perform their functions. The peculiar 
breathing and profound apparent sleep, distinguish it from an 
attack of palsy : and the absense of convulsions, makes the 
difference between it and Epileptic Fits. 

It chiefly attacks in the advanced period of life, and most those 
of short necks and large heads — of full habit of body, free eaters, 
and great drinkers of ardent spirits. The immediate cause 
of these fits, is a compression of the brain : often occasioned 
by the bursting of a blood vessel within : sometimes from the 
sympathy of the brain with the stomach — as in case of persons 
drunk, or under the operation of opium or other poisons. It is 
sometimes preceded by giddiness, pain in the head, drowsiness, 
loss of memory and faltering of the voice : though frequently it 
occurs suddenly, the person falling down without the least 
warning. 

In cases of apoplexy, the person should have the head elevate 
ed : free air admitted : all bandages or any thing compressing, 
particularly around the neck — should be removed. In persons 
of full habit, they should instantly be bled freely : particularly 
about the temples; and it is to be repeated according to circum- 
stances. They should be cupped over the head — and indeed 
the more they are cupped every where, the better. A large 
blister should be applied to the neck and shoulders. An injec- 
tion of purgative salts, with tartar emetic, should be given. 
Also large doses of calomel are to be administered. Vomits, 
after other evacuations, have been found serviceable. Mustard, 
or water nearly scalding hot, should be applied to the feet, to 
rouse the system. All who have reason to apprehend this 
dreadful disease, should live very low, on a vegetable diet, and 
lead a very industrious life, and cause the return of any sup- 
pressed evacuation or renewal of sores which have been healed. 



300 



PALSY. 



This is frequently the result of apoplexy, and is attended 
with a loss of the powers of motion and sensibility of parts of 
the body. It is produced by the same causes which produce 
apoplexy: by suppression of evacuations: by constant handling 
of lead and inhaling the fumes of poisonous metals: and by se- 
dentary and luxurious living. 

When it takes place in persons of full habits, as in apoplexy, 
free evacuations by the lancet and purges are necessary. Elec- 
tricity and galvanism have proved serviceable in chronic cases. 
When the disease affects several different parts of the body, it 
is customary to use stimulants internally and externally to the 
affected part. — Those most used are mustard seed, horse-rad- 
ish, garlic, volatile salts, ether, and oil of turpentine, in their 
ordinary doses, and to be frequently changed the one for the 
other. The parts affected with the palsy, may be rubbed with 
the volatile linament, oils of turpentine and sassafras, red pep- 
per, and Spanish flies in spirit, powdered mustard, and whipt 
with nettles — in short, any thing may be used that will irritate 
the skin. In cases attended with Joss of appetite and great 
weakness, any of the tonic, stomachic, and stimulating medi- 
cines may be given in full doses. 

Palsy of the lower extremities frequently arises from a dis- 
ease in the back bone: and the most successful treatment, is to 
keep issues or blisters constantly discharging for months from 
the surface of the part where the disease commences. Chil- 
dren are most subject to this disease. Sometimes it comes on 
suddenly, and at others is preceded by a sense of feebleness, 
languor, and numbness in the extremities — occasional stum- 
bling, and dragging the legs, instead of lifting them properly. 
If parents would early pay attention to such symptoms in their 
children, and have blisters applied at once to the back bone, 
where there seems, on feeling, to be a little tenderness, they 
would save many children from deformity for life. Issues were 



301 

formerly used; but a continued discharge from blisters, I be- 
lieve to be infinitely superior. 



EPILEPSY. 

This disease consists in a sudden deprivation of the senses; 
accompanied with a violent convulsive motion of the whole 
body. It attacks by fits, and after a certain time goes off; leav- 
ing the person in his usual state, excepting a sensation of lan- 
guor and exhaustion. 

If epilepsy appear to proceed from any suppressed discharge, 
it ought to be restored; when preceded by a costive habit, or 
worms, strong purges are requisite. If the person be of a full 
habit, bleeding from the arm should be tried, and also cupping 
the head and neck. The use of fox-glove in like cases, has 
been recommended. Opium on the approach of a fit, has fre- 
quently prevented it, or lessened its violence: and so have tight 
ligatures on the limbs. Tonic medicines have proved of ser- 
vice after the fit; particularly the metallic tonics of iron, lead, 
copper, tin, zinc, arsenic, and lunar caustic. Spirit of turpen- 
tine, in large doses on an empty stomach, has been highly ex- 
tolled. The doses of these medicines are to be found under 
their respective heads: but it may be well to remark, that in 
this disease they should be of the largest quantity. 

The same rule that is good with the intermittent fever, holds 
equally so with this and all periodical diseases. To prevent 
their recurrence, the whole system is to be revolutionized. At 
the time of the expected attack, more especially should the 
strongest action and reaction be roused. To plunge in the salt 
bath: to previously stimulate the body to a high degree: to ex- 
cite violent vomiting: to irritate the skin from head to foot: to 
excite strong action in the lower bowels by irritating injections: 
to go through a course of mercury and sulphur, as well as oc- 
casionally to take the strongest tonics, in the largest doses; are 
means I would freely resort to, in order to carry fully into ef- 
fect the great object of revolutionizing the body, in order to 
prevent the recurrence of dangerous periodical diseases. 



80S 

When a fit comes on, every practicable attention should be 
given to prevent the patient from hurting himself. Rubbing 
the nose, temples, and pit of the stomach with ether, will tend 
to lessen the duration of the attack. 



ST. VITUS DANCE. 

This disease is an irregular and comical kind of convulsive 
action, affecting principally the arm and leg of one side. It is 
occasioned b£ irritations as from teething, worms, acrid mat- 
ter in the bowels, poisons and violent affections of the mind. 
The fits discover themselves by a species of lameness; like 
that arising from palsy, and are sometimes preceded by cold- 
ness of the feet, pain in the left side, ccstiveness^ lassitude, 
anxiety, affections of the head and teeth, and then come on 
the convulsive motions. 

The disease is most common to boys and usually terminates 
at the age of puberty. When it arises from any cause operat- 
ing on the bowels, it should be removed by vomits and purges, 
repeated. When it arises from a weak, irritable habit, tonic 
medicines should be given, and I would recommend the trial of 
all separately stated under that head. Electricity, galvanism, 
and cold bath, have severally proved serviceable. The bowels 
should always be kept open. Cupping the head and back, 
blisters kept discharging on the limbs affected, at the origin of 
the disease, have also been used with advantage. But Doctor 
Hamilton, a late writer, gives a decided preference to constant 
purging over all other remedies. 



APPARENT DEATH. 

In consequence of drowning, or a long exposure to the action 
of severe cold, and also of suffocation, and strangulation, a 
great check is often given to the vital principle without its be- 
ing wholly extinguished. 



303 

It has "been supposed that in the act of drowning, the water 
enters the lungs and completely fills them. This is not the 
fact; for unless the body lies so long in the water as entirely to 
extinguish life, the quantity of water in the lungs is inconsid- 
erable. 

In those cases where a person has been long exposed to se- 
vere cold, and is suffering from great numbness, a kind of in- 
toxication comes on; he is apt to fall quickly asleep and become 
quite insensible. Occasionally he comes to himself without 
assistance, but more frequently he falls a sacrifice. 

When a person dies from suffocation, the symptoms are 
nearly the same as in apoplexy. The symptoms which cha- 
racterise strangulation are convulsive fits, in addition to the 
apoplectic symptoms. 

Livid and dark spots on the face, with great rigidity and 
coldness of the body, a glassy appearance of the eyes, and a 
soft state of the skin, denote a perfect extinction of life : but the 
only sure sign is actual putrefaction— and therefore, in every 
case where this symptom is not present, and where we are un- 
acquainted with the length of time the body may have been 
under water, every possible means should be employed, imme- 
diately upon its being founds for restoring life — as it may never- 
theless still retain, in some degree its vkal powers. 

The following are the means to be employed for the recovery 
of persons recently drowned : — 

As soon as the body is taken out of the water, it is to be 
speedily stripped of its wet clothes, wiped dry, and covered with 
a warm blanket. It is then to be carried to the nearest house, 
there to be laid between warm blankets, spread upon a mat- 
tress or low table, and on the right side in preference to the 
left, in order that the passage for the blood to the heart may 
be favoured by the position. The head is at the same time to 
be covered with a woollen cap, being properly elevated with 
pillows; and bags filled with warm sand, or hot bricks wrapped 
in flannel, are to be applied to the feet. The doors and win- 
dows of the apartment are to be thrown open, in order that 



304 

the cool air may be freely admitted, and no persons other than 
necessary assistants should be allowed to enter it. 

You should next endeavour to expand the lungs, and make 
them if possible, reassume their office. When not furnished 
with a flexible tube made of elastic gum, or with the bellows 
invented by Hunter for this express purpose, you must blow in 
air by mean's of the common bellows; or by inserting a pipe in- 
to one nostril, compressing the other, shutting the person's 
mouth at the same time, and then blowing through the pipe 
with a considerable degree of force. By any of these means, 
you may be able to inflate the lungs. 

At the same time that the lungs are inflated, you should rub 
every part of the body with warm flannel cloths. On all occa- 
sions, it will be proper to divide the assistants into two sets; 
the one in endeavouring to restore heat to the body, the other 
in instituting an artificial breathing in the manner just pointed 
out. Should the frictions not be attended with any effect, you 
ought to apply flannel cloths, wrung out in very hot water, 
over the heart and chest, or you may put the person in a very 
hot bath. A high degree of heat will not be necessary; a mo- 
derate degree will be sufficient. If the weather be under the 
freezing point, and the body when stripped feel cold, and near- 
ly in the same condition with one that is frozen, it will be ne- 
cessary at first to rub it well with snow, or wash it with cold 
water; the sudden application of heat in such cases having been 
found highly pernicious. In a short time, however, warmth 
must be gradually applied. 

Hanging the patient by the heels, or rolling him over a bar- 
rel as is sometimes practised by the ignorant, under the mis- 
taken idea of expelling the water from the stomach and lungs 
is most dangerous and only calculated to extinguish life if any 
remain. 

When the patient is so far recovered as to be able to swal- 
low, he should be put into a warm bed, with his head and shoul- 
ders properly elevated with pillows. Warm wine whey, or 
any other light and nourishing drink, should now be given in 
moderate quantities at a time, and a gentle perspiration pro- 



305 

moted by wrapping the feet and legs in flannels wrung out of 
hot water, with about an ounce of purgative salts dissolved 
in it, and a little oil may be administered. 

The patient should on no account be left alone, until the 
senses are perfectly restored, and he is able to assist himself, 
as some persons have relapsed and been lost from the want of 
proper attention to them, after the vital functions were to all 
appearance tolerably established. 

In cases where life has been suspended by hanging, the 
same means recommended for drowned persons are to be 
pursued, with the addition of opening the veins of the neck 
or cupping the neck, which will tend considerably to facili- 
tate the restoration of life, by lessening the quantity of blood 
contained in the vessels of the head, and thereby, taking off 
the pressure from the brain. Except in persons of a full 
habit, the quantity drawn off need seldom exceed an ordinary 
tea cup full, which will in general, be sufficient to unload the 
vessels of the head without weakening the power of life. 

The treatment to be adopted in cases of exposure to severe 
degrees of cold, should be as follows: 

The person should be removed with all speed to a convenient 
place, where the necessary aid can be given. If the body is 
naked, it should be covered, leaving the head and face bare. If 
snow can be procured, the body may at first be gently rubbed 
with it, from the stomach to the extremities. In a few minutes 
afterwards, the frictions may be made with cloths steeped in 
cold water, the temperature of which is to be increased, so 
as to heat the body gradually and equally; the face may at 
the same time be sprinkled with water, the lips and nostrils 
may be irritated with a feather and volatile alkali, or some such 
stimulant. As soon as the body is restored to some degree of 
warmth, and the limbs become somewhat flexible, the person 
should be placed in a dry but not warm bed, and be well rub- 
bed with flannel or a brush; his lungs may also be inflated, and 
an irritating clyster, such as rum, brandy or gin, and water, 
ike. be administered from time to time. 

When the power of swallowing is restored, you should give 
the person some warm and gently stimulating drink; such a& 
N n 



806 

thin broth with a little brandy in it, or water with some wine; 
which may be administered by a spoonful at a time. 

For the sake of humanity, it is necessary to observe, that in 
all cases of sudden apparent death here treated of, the body 
should not be prematurely interred. In many cases, the unfor- 
tunate subject has thus been deprived of a life, which might by- 
proper means have been preserved to him. 



CRAMP IN THE STOMACH FROM DRINKTNG COLD WATER. 

Dr- Rush says, three circumstances concur to produce dis- 
ease or death from drinking; cold water: First, the patient is 
extremely warm; second, the water is extremely cold; and third, 
a large quantity of it is suddenly taken into the body. The dan- 
ger from drinking is in proportion to the degrees of combina- 
tion which occur in the three circumstances mentioned. 

In a few minutes after the patient has swallowed the water, 
he is affected by dimness of sight; he staggers in attempting 
to walk, and, unless supported, falls to the ground; he breathes 
with difficulty; a rattling is heard in his throat; his nostrils and 
cheeks expand and contract in every act of respiration; his 
face appears suffused with blood, and of a livid colour; his ex- 
tremities become cold, and his pulse imperceptible: and un- 
less relief be speedily obtained, the disease terminates in death 
in four or five minutes. 

This is an account of the less common cases of the effects 
of drinking a large quantity of cold water when the body is 
preterm atu rally heated. More frequently the patient is seiz- 
ed with acute spasms in the breast and stomach. These spasms 
are so painful, as to produce fainting. In the intervals of the 
spasms, the patient appears to be perfectly well. The inter- 
vals between each spasm become longer or shorter, according 
as the disease tends to life or death. 

It may not be improper to notice, that punch, beer, and even 
toddy, when drank under the same circumstances as cold wa- 
ter, have ail been known to produce the same morbid and fatal 
effects. 



soy 

The means to be tried for giving relief is strong stimulation, 
by large doses of liquid laudanum, ether, spirits, Sec; and, 
above all, it is necessary that the patient should not be permit- 
ted to remain for an instant in a recumbent posture; but should 
be kept in constant motion until relieved. The doses of lauda- 
num, as in other cases of spasms, should be proportioned to 
the violence of the disease. From a tea to near a table spoon- 
ful has been given in some instances, before relief was ob- 
tained. Where the powers of life appear to be suddenly sus- 
pended, the same remedies should be used which have been so 
successfully employed in recovering persons supposed to be 
dead from drowning. Care should be taken in this, as in all 
cases of apparent death, to prevent the patient's suffering from 
being surrounded or attended by too many people. 

Persons who have been recovered from the immediate dan- 
ger which attends this disease, are sometimes affected, after it, 
by inflammations and obstructions in the stomach, breast, and 
liver. These generally yield to the usual remedies which are 
administered in those complaints, when they arise from other 
causes. 

To prevent the fatal effects from drinking cold water, the 
following rules are given by the Doctor: 

1. Grasp the vessel out of which you are about to drink, for 
a minute or longer, with both your hands. This will abstract 
a portion of heat from the body, and impart it at the same time 
to the cold liquor, provided the vessel be made of metal, glass, 
or earth; for heat follows the same laws, in many instances, in 
passing through bodies, with regard to its relative velocity, 
which we observe to take place in electricity. 

2. If you are not furnished with a cup, and are obliged to 
drink by bringing your mouth in contact with the stream 
which issues from a pump, or a spring, always wash your 
hands, previously to your drinking, with a little of the cold 
water. By receiving the shock of the water first upon those 
parts of the body, a portion of its heat is conveyed away, and 
the vital parts are thereby defended from the action of the 
cold. 



308 



POISONS. 



Poisons are of the Mineral, Vegetable, and Animal kinds. 
Mineral poisons are to be distinguished from vegetable ones 
by their action. 

The former corrode, stimulate, or inflame; the latter gene- 
rally stupify, and leave no mark of inflammation. None of the 
mineral poisons terminate life, till after a most excrutiating 
operation of two or three hours at least; whereas some of the 
vegetable class, destroy it in a few minutes. From the animal 
poisons the destruction is as striking; for although in the 
plague, the mouth and throat are frequently affected in the 
same way, yet the local disease of the stomach is never present. 
The aerial poisons operate still more' quickly than any of the 
other classes, and their action on respiration is so peculiar that 
it can never be mistaken. 

In all cases where poisons are taken into the stomach, the 
first mean of relief to be used is, to evacuate the stomach by 
irritating the throat with a feather and giving a large dose of 
white vitriol, drinking freely of warm water. 

It has been recommended, j$ introduce a catheter into the 
stomach and pump out the contents. This has in several in- 
stances been practised with success. It has also been recom- 
mended to inject a solution of three or four grains of tartar 
emetic into the veins to excite vomiting, also ten or twenty 
grains into the bowels. 

Where an inflammation of the stomach and intestines is conse- 
quent upon taking poisons into the stomach, it should be treat- 
ed in the same manner as any other inflammation. The whites 
of several eggs, beat up and given to the patient every half 
hour, is recommended where mineral poisons have been taken. 
Any mucilaginous drink will be proper. 



309 



BITES OF MAD DOGS, SNAKES, &c. 

The most common time of the appearance of madness, from 
the bite of a mad dog-, is from twenty to forty days after the 
bite; but in some cases, a few days only have elapsed previous 
to the symptoms shewing themselves. There are no well 
authenticated instances of the poison lying dormant longer than 
eleven or twelve months; and we may therefore consider a 
person pretty safe at the expiration of a year, without any 
symptom appearing. 

The general symptoms attendant upon the bite of a mad dog, 
or other rabid animal, are : The part bitten, after some time 
begins to be painful; then come on wandering pains, with an 
uneasiness and heaviness, disturbed sleep and frightful dreams, 
accompanied with great restlessness, sudden starting and 
Spasms, sighing, anxiety, and a love of solitude. These symp- 
toms continuing to increase daily, the scar of the wound be- 
comes hard and elevated, a peculiar tingling sensation is felt 
in the part, and pains begin to shoot from the place which was 
wounded up to the throat, with a straightness and sensation of 
choaking, and a horror and dread at the sight of water and 
other liquids. The patient is however capable of swallowing 
any solid substance with tolerable ease, but the moment any 
thing in a fluid form is brought in contact with the lips, it oc- 
casions him to start back with dread and horror, although he 
labours perhaps under great thirst at the time. 

This appears to be a circumstance peculiar to the human, 
race, for mad animals do not evince any dread at water. This 
madness when once manifested in the system, the power of me- 
dicine, and all human skill, have failed, in most instances to cure. 
Our views should be early directed to prevent the accession of 
the disease : and for this purpose, the most effective means are 
to cut out the wounded part and wash it freely. Immediately 
therefore on the infliction of the bite, or as soon after as possi- 
ble, free washing with soap or lie should be prescribed — and it 
is to be continued until a physician can be had. On the arri- 



310 

val of the surgeon, the bitten part is to be freely taken away, 
care being had to carry the knife to a sufficient depth, so as to 
ensure its complete removal. Burning with a hot iron or the 
application of caustic, or mineral acids should be used, where 
a surgeon cannot readily be procured. 

It has been recommended to excite a salivation in the patient, 
by administering corrosive sublimate- — three grains, dissolved 
in one ounce of strong spirit; half of this mixture is to be taken 
undiluted at going to bed: it produces a copious salivation for 
almost an hour and a half. Some laxative medicine is to be 
taken the second day: and the dose of mercury repeated on the 
evening of the third day, to be followed in like manner by a 
second laxative. 

It has sometimes been recommended to stimulate the patient 
freely after madness has come on, and sometimes to bleed and 
purge. But unfortunately the issue is almost in every case fa- 
tal. The chance rests on prevention. 

When one is bitten by a venomous snake, the patient should 
instantly tie a bandage around the part, to retard the circula- 
tion. The part should then be either cut out, or destroyed by 
caustic. Soap lees and volatile alkali are highly extolled as a 
wash: and the volatile alkali should be taken internally. The 
internal use of opium is requisite when the pain is violent. 



SCALDS AND BUFNS. 

In almost all cases of burns and scalds, there arises, soon af- 
ter the infliction of the injury, a sense of coldness amounting 
to shivering. This commonly goes off; and in those cases 
where there is increased action alone, the symptoms of inflam- 
matory fever come on. But when the injury has been more 
violent, when exhaustion has followed immoderate excitement, 
the shivering is severe and long continued, and seldom follow- 
ed by reaction. 

In all accidents from scalds and burns, it seems to be of the 
utmost importance to apply a remedy at the instant; for by 
this means the violent anguish is allayed, and blistering, which 



311 

in scalds, at least, is usually so considerable as to lay the foun- 
dation for a tedious curative process, is in a great degree pre- 
vented. Of the remedies most quickly to be procured on such 
occasions, plunging the part affected, without a moment's delay, 
into very cold water, to be frequently renewed, is the best. The 
transition from torture to ease, will be almost instantaneous. — 
Water is always at hand; and after proper immersions in it for 
a due length of time, it may be sufficient to cover the injured 
parts with linen rags, moistened therewith, blowing over them 
from time to time streams of air, by means of a small tube or 
bellows, until the sense of coldness is produced sufficiently. — 
By this simple process, a large piece of skin that has been 
burned to the appearance of charring, and surrounded by a 
high degree of inflammation, has been perfectly cured in the 
course of a very short time; no ulceration taking place, but the 
crust coming off dry, and leaving a sound surface underneath. 
Of late, the application of ice has been much recommended by 
a few practitioners of eminence. 

It has long been the practice of St. Thomas's Hospital, in 
cases of burns and scalds, to smear the parts well with a fea- 
ther dipped in mixture of olive oil three ounces, and lime wa- 
ter six ounces; but it seems a very inefficacious application; 
and I think it will be - more adviseable to apply linen cloths, 
wetted with either cold water, or a solution of lead water, as 
long as the parts are heated, and inflamed. When the inflam- 
mation subsides, this mixture may be used, or we may employ 
the lead ointment spread on fine lint, as the dressing. Poul- 
tices of potatoes, carrots, turnips, &c. are frequently used with 
great success. 

Dr. Kentish says, in cases where the skin is not destroyed but 
reddened, he has found nothing better for the first application 
than the heated oil of turpentine, or basilicum ointment thin- 
ned with the same. In superficial burns, where the pain has 
ceased, it will be adviseable to desist from this application in 
about four and twenty hours, as that time in many cases will 
be sufficient; and at the second dressing, a stimulating oint- 
ment, thinned with common oil, will be adequate to the cure; 
and on the third dav beein with Turner's cerate or lead 



818 

ointment. He says that he has frequently seen secondary in- 
flammation excited by the remedy, which in the first instance 
puzzled and perplexed him considerably: and, that he has been 
informed of this consequence by several gentlemen; The most 
certain remedy for this unpleasant symptom, is to apply a 
plaster of basilicum ointment thinned with oil, or a plaster of 
lead ointment, and over that a large warm poultice. Should 
there be much uneasiness of the system, anodynes proportioned 
to the age of the patient should be given. 

Ether or rectified spirits, applied in such a manner as to fa- 
vour its speedy evaporation, and thereby, the abstraction of 
heat, may be still more efficacious than the remedies mention- 
ed. When there is no exposure from a separation of the skin, 
the aether or strong spirit somewhat diluted, may be evaporat- 
ed from the skin by keeping a piece of thin linen cloth wetted 
therewith over the injured parts, and moistening it from time 
to time; but when the injured parts have been deprived of their 
natural skin, it will be adviseable to lay immediately over them 
a piece of thin bladder, and then the linen cloth, as before; 
keeping it continually moist by squeezing a cloth wetted with 
the evaporating liquid over it. As long as the pain and heat 
last, this process should be continued; but as soon as the in- 
flammation is subdued, the process of evaporation should be 
discontinued, lest too great an abstraction of heat should be 
occasioned. 

To alleviate pain and procure rest, in cases where the injury 
is extensive, as likewise, in those cases in which there is a 
severe shock given to the nervous system, as occasionally hap- 
pens in injuries of this nature, it will be right to have recourse 
to opiates in such doses as shall be found sufficient to alleviate 
the severity of the pain and nervous irritation. 

When feverish heat ensues, gentle laxatives should be given; 
such as salts, cream of tartar, See. 

If the parts become livid and black, so as to threaten the 
coming on of a mortification: then bark and wine, with the 
other means advised to give tone, must be resorted to. 

Between the advocates for the adoption of a cooling treat- 
ment, and those who recommend a stimulating one, there 



313 

seems indeed a perfect opposition both in theory and practice. 
My opinion is, that the cooling treatment will be most advise- 
able, while the sensation of heat and pain exists; but when 
these are removed, and symptoms of weakness occur, or when 
they primarily appear, the stimulant plan ought to have the 
preference. Remember the ointment is never to touch the 
sound parts. 

Much certainly depends upon the constitutional variety of 
the subjects, as well as on the different stages or degrees of the 
accident. When no other inconvenience than a slight blis- 
tering of the injured parts is sustained, no remedy can be more 
aptly resorted to than the application of cold water; but when 
the skin is so burned that it is entirely destroyed, the parts are 
affected with severe blistering and pain, and there is at the 
same time but little reaction in the system, then the stimulant 
qualities of the turpentine application, supporting the powers 
of life at the same time with cordials and appropriate nourish- 
ment, will certainly be preferable — as the sedative effect of 
cold under such circumstances, might extinguish the vital 
principle. 

The sores left by burns have some peculiarities. They shoot 
out fungous, or firoud Jlesh as it is vulgarly called; they are dif- 
ficult to heal: and when they do heal, contract so much as of- 
ten to produce great deformity. 

To arrest the growth of this over-growing jlesh, sprinkle the 
part with powdered chalk .which has been washed and dried, 
or burnt alum, or rhubarb, or apply lunar caustic. 

It is very important that you should carefully prevent the 
coming together of parts that have been burnt, which ought 
not to be united. From neglect of this, great mischief has ari- 
sen. When, therefore, there is danger of this union, be sure to 
separate the parts by interposing plasters between them: and 
when the joints, as those of the fingers, are burnt, they should 
be kept in their natural state by splints and bandages. 

The ordinary dressings for sores from burns, should be those 
of the most simple kind. The lead ointment will generally 
prove the best. 

O o 



314 



INVOLUNTARY DISCHARGES OF BLOOD. 

The general object in these cases, is first to put a stop to 
the discharge of the blood ; and second to prevent its recur- 
rence, by removing the causes by which they were excited* 
and by correcting the inflammatory state of the system, when 
it exists. The particular means remain to be pointed out,, 
under the subsequent heads. 



BLEEDING AT THE NOSE. 

* 
In the nose there is a considerable net-work of blood-vessels ? 

expanded on the internal surface of the nostrils, and covered 
only with a thin skin, and hence upon any determination of a 
greater quantity of blood, than ordinary to the vessels of the 
head, those of the nose are easily ruptured. In, general the 
blood flows only from one nostril; but in some cases it is dis- 
charged from both. 

Bleeding at the nose comes on at times without any previ- 
ous warning, but at others it is preceded by a pain and heavi- 
ness in the head, ringing in the ears, flushing in the face, heat 
and itching in the nostrils, and a quickness of the pulse. In 
some instances a coldness of the feet, and shivering of the 
whole body, together with costiveness, precede this bleeding. 

The complaint is seldom dangerous in young persons; but 
when it arises in those more advanced in life, flows profusely, 
and returns frequently, it indicates too great a fulness of the 
vessels in the head, and not unfrequently precedes apoplexy, 
palsy, Sec. and therefore in such cases is to be regarded as a 
dangerous disease. 

As a bleeding from the nose proves salutary in some disor- 
ders, such as giddiness and head ache: and is critical in others, 
such as phrenzy, apoplexy, and inflammatory fever, where 
there is a determination of too great a quantity of blood to the 
head; we ought properly to consider the circumstances under 



/ 



315 

which it happens, to decide whether it is really a disease or 
intended by nature to remove some other. 

When it arises in the course of some inflammatory disorder, 
or in any other where we have reason to suspect too great a 
determination of blood to the head, we may suppose that it will 
prove critical, and therefore we should suffer it to go on, at 
least as long as the patient is not weakened by it. 

Neither should it be suddenly stopped, when it happens to 
persons in good health, who are of a full habit. In short, where 
this bleeding relieves any disagreeable symptom, and does not 
proceed so far as to induce weakness, it ought not to be hastily 
checked* But when it arises in elderly people, or returns fre- 
quently, or continues till the patient becomes weak, it ought to 
be stopped as quickly as possible 

In cases of very full habit, it is sometimes proper to take 
blood from the arm. Persons subject to regular returns of it, 
ought before the expected time to undergo some evacuations 
and avoid all exciting causes: as strong passions, stimulating 
drinks, and holding down the head. Very effectual and com- 
mon means of stopping it, are to bathe the head in cold water, 
and to set in a tub of the same, which produces a general con- 
striction of the vessels, Ice or iron to the back will be good. 
Powdered charcoal taken as snuff, will often relieve; it may also 
be put up the nose by dipping a wet rag in the powder and 
pushing it up the nose. Sometimes a small gut pushed up to 
the further part of the nose by a probe or wire, with the end 
of the gut tied; when the end hanging out is to be filled with 
cold water, by means of a syringe, so as to produce compres- 
sion on the bleeding vessels; where it is to remain for some 
time, will relieve. 

I have injected up the nose, a strong solution of* sugar of lead 
with success: also, alum water. The drink, in such cases, 
should be cold water with a little of elixir vitriol. 

The only certain remedy is mechanical: it is to push a wire 
through the nose and pull it out at the mouth: when to its end, 
a small piece of sponge is to be attached, which is then to be 
pulled up to the .back of the nose: this will close the orifice 
behind, and that in front is to be closed with the finger. 



316 



SPITTING OF BLOOD. 

This is a more alarming disharge of blood than that from 
the nose; but is almost equally under the control of art; it 
often arises from the same causes, and is to be treated in many 
instances in a similar way. 

The discharge is of a bright red colour, brought up by 
hawking and spitting, frequently preceded by a saltish taste in 
the mouth, a sense of heaviness about the heart, difficult and 
painful breathing, and dry, tickling cough. It differs from 
blood brought from the stomach, for that from the latter is of 
a more dark and coagulated appearance. It most commonly 
occurs at ages from fifteen to thirty, and may be occasioned 
by any violent action of body or mind: by the suppression of 
accustomed evacuations: by a rarified air; and most frequently 
takes place in persons of long necks and narrow chests: often 
in families subject to similar complaints. It is seldom fatal; 
and only so, when a large blood-vessel has bursted. 

If the patient be feverish and of full habit, bleeding, rest, 
purges of salts, and cold air, are requisite. Setting in a tub of 
cold water, has sometimes arrested the discharge. The medi- 
cines under the head of astringents, to which I refer, have been 
separately recommended. Dr. Rush recommends taking one 
or two table spoonfuls of salt. The tincture of fox-glove, has 
often been judiciously administered in small doses, repeated 
three or four times a day. The sugar of lead in doses of one 
or two grains is a powerful remedy: it is to be repeated every 
three or four hours. Blisters to the chest have been recom- 
mended. I have used ligatures around the limbs with great 
advantage. Cupping freely the chest and limbs, I should pre- 
fer to blisters. 

When the bleeding ceases, the greatest care is requisite 
to prevent its recurrence. The means of doing so may be 
summed up in a few words: determine the blood to other parts. 
Ride on horse back: have the skin frequently cupped and rub- 
bed: take exercise which requires a free use of the arms. Live 



317 

rather on a spare than full diet; and carefully guard against 
exposure to cold and moisture, or any thing producing colds; 
and avoid much talking. 



VOMITING OF BLOOD. 

This is usually preceded by a sense of heaviness, and pain 
about the stomach; it is unaccompanied by cough. The dis- 
charge is of a dark colour; and is occasioned by suppressed 
evacuations, affections of the liver, and from blows, and irritat- 
ing matter, in the stomach. The treatment is the same as in 
other discharges of blood; reduce the system by bleeding, if it 
be vigorous; cold drinks will be proper. In cases resisting such 
treatment, small doses of the sugar of lead, may be necessary; 
ten or twenty drops of the muriated tincture of iron, in water, 
is supposed to be the best medicine to stop the mouths of the 
bleeding vessels of the stomach. Dr. Hamilton recommends 
free purging, in the cases of females, who have vomiting of 
blood attended with a suppression of the menses. The appli- 
cation of a blister to the belly has been recommended. A dose 
of powdered charcoal is a good remedy. Cold applications 
over the stomach for a short time may prove of service: and 
so may injections of cold water in the bowels. The diet, 
after this discharge, should be of the least bulky or irritating 
nature: nutritious, mild jellies; milk, and the like, — without 
spices or spirit. 



VOIDING OF BLOOD WITH URINE. 

This disease often arises from a stone in the parts concerned 
in the preparation of urine. When the stone cannot be remov- 
ed, the pain will be lessened by drinking plentifully of those 
drinks called mucilaginous, or slimy, which I have so often 
enumerated. 

It is also occasioned by falls, blows, bruises about the belly, 
hard riding, jumping, Sec. When the person affected is of full 



318 

habit, bleeding is requisite in proportion to strength. Purges 
of salts are recommended, and small doses of nitre every two 
or three hours. Should it continue, doses of the oak bark, of 
alum, 01 gum kino, lastly of sugar of lead, should be given. — 
When the pain is violent, from whatever cause the bleeding 
arises, doses of laudanum may be administered. The plant 
called uva ursi, is recommended, in doses repeated two or three 
times a day. A pint of a strong decoction of *peach leaves, 
made by boiling an ounce and a half of the dried leaves in a 
quart of water to a pint and a half, and given throughout the 
day, is stated on good authority to have effected a perfect cure 
when other remedies failed. Whatever maybe the cause of 
the bleeding, the warm bath is to be tried, and drinks of the 
mild mucilaginous kind continued, 



VOMITING AND PURGING. 

This disease, called Cholera Morbus, is marked by a frequent 
and violent discharge from the stomach and bowels, of a dark, 
bilious looking matter. It is usually brought on by eating un- 
common food, rancid meats, crabs, tainted fish, and sometimes 
by over-doses of medicine. It comes on with sickness at sto- 
mach, soreness and distention of bowels, painful griping, flatu- 
lency, heat, thirst, quick respiration, and a frequent and flutter- 
ing pulse. — In the worst cases, clammy sweats, cramp and cold- 
ness in the extremities, irregularity in the pulse, hiccup; spee- 
dily terminating in death. 

The cure is to be attempted by giving large doses of lauda- 
num — to be repeated although thrown up. A watery solution 
of opium, is sometimes better; repeated injections of the same, 
are to be tried: as also injections of starch, and of sugar of lead, 
as this last tends to restrain action. Cloths dipped in hot 
water, in spirit, in spirit of camphor, or red pepper, are to be 
applied repeatedly to the breast and belly. Applications of 
hot bricks or bottles of water, are to be made to the feet. A 
blister over the stomach, of mustard powder: or better of Span- 
ish flies boiled with oil of turpentine, because quicker in ope- 






319 

rating. In case of great danger, I would scald the part. In 
this dreadful disease, many articles are to be tried. Chicken 
water; doses of elixir vitriol, columbo root, chalk, the saline 
mixture, lime water, hot toddy, spiced wine, porter, have seve- 
rally afforded relief when other means failed: and so have strong 
decoctions and tinctures of all our spices and essential oils, 
particularly of peppermint, of cinnamon, and aniseed. In the 
worst cases, I would bathe the whole body with spirit, impreg- 
nated with red pepper, or with spirit of hartshorn. 

Should the patient recover, the tonics and strengthening me- 
dicines are to be given in small doses, though not when there 
is danger of their irritating the bowels. The diet should be of 
the most nutritious jellies, and broths well seasoned. He 
should have his skin well rubbed every night and morning: 
wear flannel next his skin, and abstain from all things to which 
he is not habituated; carefully avoiding exposure to a cold, 
damp air. 

In attacks of this disease, of a mild degree, it is best to 
begin the treatment by giving a dose of calomel, to evacuate 
the bowels and to operate as a stimulus, to relieve their dis- 
ased action. In cases where the disease is a symptom only of 
high fever, the patient must be blooded, the calomel repeated, 
and those stomachics given which are not of a heating nature; 
in short, to be treated as for fever. 



DYSENTERY, OR FLUX. 

This is an inflammation of the inner coat of the bowels, ac- 
companied with severe griping, frequent inclination to go to 
stool, and some degree of fever. The stools, though frequent, 
are small in quantity — not of a natural state, but consisting 
principally of mucus, sometimes streaked with blood. When 
the natural evacuations do appear, they are usually in the shape 
of small, compact and hard substances, resembling irregular 
balls. 

This disease is most prevalent in warm countries, about the 
autumn, and when the system is rendered irritable by the o- re at 



320 

heats of summer and then suddenly exposed to cold or mois- 
ture. When the inflammation begins to occupy the lower part 
of the bowels, the stools become more frequent and less abun- 
dant, and in passing through the inflamed parts, they occasion 
great pain and griping; there is then great rumbling, and unu- 
sual flatulency in the bowels. The motions vary considerably; 
being sometimes composed of frothy mucus, streaked with 
blood: at others, of acrid, watery matter, like the washings of 
meat, and very offensive to the smell. Sometimes pure blood 
is voided: then lumps of mucus, resembling bits of cheese, and 
lastly common matter. It sometimes happens that in the violent 
straining, parts of the bowels are protruded, and become a 
source of increased suffering. 

For the cure of dysentery, it is all-important not to neg- 
lect it in the beginning. In the first stage, if the patient be 
young and of a full habit of body, early blood-letting is proper. 
In general, the cure may be commenced with an emetic, fol- 
lowed by one or two purges of calomel. Some antimonial medi- 
cine, as cerated glass of antimony, golden sulphur of antimony, 
or tartar emetic, all in small doses every two hours, to keep up a 
determination to the skin, is very proper. The purging should 
be repeated, with castor or olive oil, day after day. When the 
discharges from the bowels are offensive, prepared chalk, in 
doses of two tea spoonfuls, should be given. Injections of cold 
mucilaginous liquid in the bowels, will prove serviceable. I 
have frequently had injected, with great advantage, five grains 
of sugar of lead in a pint of water. In cases of violent pain, the 
region of the stomach should be bathed with laudanum and spi- 
rit of camphor, and cloths from hot water constantly applied 
over the belly. A blister over the stomach, will tend to relieve 
the internal inflammation. When the belly is hard and sore 
to the touch, it should be well bathed with olive oil — if not to 
be had, with common fat; flannels taken from a hot watery 
solution of opium and applied to the part, will render service. 
The general warm bath is highly recommended: and while in 
it, the skin should be well rubbed. 

" The drinks should be of the mildest and most mucilaginous 
kind. Slipery elm bark tea: flax, quince, and melon seed tea: 



321 

the root of the cat-tail plant of our marshes, gum arabic, cherry 
or peach tree gum in solution, arrow root, &c. are to be given 
freely. Injections of the same should be given, and the patient 
should not frequently indulge the desire to go to stool, as it in- 
creases the disease. 

At the commencement of dysentery, it would be improper to 
give opiates, or astringents; but after the inflammatory symp- 
toms have subsided, these medicines may be judiciously given; 
taking care still to keep the bowels moderately open. The in- 
troduction into the fundament of three or four grains of opium 
in a pill, will often allay the irritation of the lower gut, which is 
apt to continue troublesome. When the inflammatory action 
subsides, the disease is to be treated pretty much as diarrhoea 
or looseness — to which I refer you. When the liver in these 
cases is affected, as is often the case, a course of mercury or 
nitric acid, will be serviceable — together with frictions of the 
skin, wearing flannel next to it, and exercise on horseback. 



CONTINUED LAX, OR LOOSENESS OF THE BOWELS. 



This complaint, called technically Diarrhcsa, is a too frequent 
discharge of matter from the bowels, in consequence of their 
increased motion and secretion. The appearance of the stools, 
is very various: being sometimes thick, thin, slimy, whitish, 
yellow, green, dark, brown, &c. Each discharge is usually 
preceded by a sense of weight in the lower part of the belly 
and the motion of wind in the bowels, which are relieved by 
the evacuation for the time. The disease is unattended with 
fever, and is no way contagious. It may be considered as a 
consumption of the bowels. It most frequently occurs in el- 
derly persons: and in those who have been intemperate, or ex- 
posed to any cause disordering the liver. 

The immediate cause of this affection of the bowels, is gene- 
rally exposure of the skin to continued cold: or to some matter 
disagreeing with the stomach and bowels, as worms, bad food 
and drink. 



The treatment, as in all other cases, must depend on the state 
of the system. When in persons of full habit, bleeding is pro- 
per: and I have known it to be repeated with advantage. I 
would not undertake to recommend the practice; but I have 
sometimes, with advantage, given a large dose of calomel: 
which purging freely, has emptied the secreting vessels and 
left them in a quiescent state. But the general practice is to 
commence the treatment by giving a vomit: which acting on 
the stomach, diverts the action from the lower part of the bow- 
els. When griping attends this disease, applications of hot, 
wet cloths, should be made to J;he belly. 

When the disease arises from suppressed perspiration, this 
is to be restored by the general hot bath: and when in it, the 
patient is to be well rubbed from head to foot, and take one 
grain of tartar emetic, to aid in determining to the skin. — 
When it arises from worms, it is only to be relieved by their 
expulsion; and the same, if from any other matter in the 
bowels. 

But the disease often seems to proceed from no visible cause, 
and gradually consumes the patient. In this case, we treat it 
as an original disease: we have to pay great attention to the 
quality of the contents of the bowels, as well as to prescribe 
solely to correct their diseased action. 

When any thing sour or offensive, is perceived in the sto- 
mach, or in the discharges from the bowels, a tea spoonful of 
prepared chalk in a little milk or mucilage, should be given 
twice or thrice a day, with the addition of a little of the essen- 
tial oils, either of peppermint, cinnamon, or aniseed: particu- 
larly if there be much sense of weakness of the stomach. The 
mild alkalis of potash or soda, are equally good, and common 
ley is of the same kind. Lime water has occasionally afforded 
some relief. Opium may frequently be given with advantage. 
In the weakened state of the system, either and all of the as- 
tringent medicines are to be tried successively. The best, I 
believe to be very small doses of sugar of lead, if it does not 
gripe, and a decoction of the due-berry root. But remember, 
that the bowels are not to be made costive: an evacuation must 
be had every day; and when they are much enfeebled, you are 






323 

to resort to a temparate use of tonics: rust of iron and the oak 
bark, I would prefer. A large flannel roller around the belly, 
so as moderately to compress and support it, has often render- 
ed essential service. 

Pure port wine, or French brandy and water, in the weaken- 
ed state of this disease, may be taken in moderation. Jellies 
and rich soup, made palatable, aiford a good nourishment.— 
Care should be taken to avoid all articles to which the patient 
is not accustomed, and all exposure to cold; and he will find 
great relief from the daily hard rubbing of the skin, and no less 
from having his belly and side, over the liver, very frequently 
dry cupped. 

When the disease of the liver is supposed to cause the loose- 
ness, the remedies under that head are of course to be applied. 



COMMON COLIC. 

This is a painful distention of the whole of the lower part of 
the belly, with a sense of twisting and boring, about the navel 
particularly, and all the parts feel as if tightly bound and com- 
pressed. It is often accompanied with vomiting, costiveness^ 
and a contraction of the muscles of the belly. It does not usu- 
ally come on with fever; but should it continue, fever is sure to 
ensue, 

The disease is produced by various causes, particularly indi- 
gestible food — that which the person is unaccustomed to: by 
costiveness, an acrid or putrid state of the contents of the bow- 
els, worms, metallic poisons, fermented liquors giving up their 
fixed air, checked perspiration, Sec. 

When the colic arises simply from wind in the bowels, the 
^carminative medicines afford relief. Fennel seed tea, volatile 
alkali, calamus root chewed, a drink of toddy, a dose of pep- 
permint, the same of aniseed oil, tight pressure on the belly, 
forcing a stool by an injection or introducing a piece of soap 
up the anus, and such common means, afford relief. 

But when the disease arises from great costiveness, and is 
attended with inflammation, vomiting of bilious matter, those 



324 

means of cure are very improper. The bilious colic is attend- 
ed with vomiting of bile, (ascertained by its bitter taste in 
the mouth) loss of appetite, feverish heat, great thirst, soreness 
of the belly, griping-, &c. 

In the worst degrees of this disease, there is an inversion of 
the motion of the bowels: and instead of discharging their con- 
tents downwards, the excrement is vomited upwards; consti- 
tuting an almost incurable disease, called the Iliac Passion. 

In all cases where the strength of the patient will allow of 
it, bleeding, and that freely, is an essential remedy. A large 
dose of calomel should be given, followed by doses of salts and 
other purgatives, until there is a free discharge from the bow- 
els. One of the best remedies, is the injection up the bowels 
of ten or twelve grains of tartar emetic. Cold water should be 
poured on the belly, if two or three doses of the purgatives do 
not operate. An injection of a decoction of tobacco, made by 
putting a drachm in a pint of a hot water, has removed the 
spasm; I should prefer applying to the belly a stronger decoc- 
tion, by cloths; sometimes a little of it has been given through 
the mouth with advantage. Very frequently calomel has af- 
forded immediate relief, when given with a large dose of 
opium. 

When the pain is violent, the patient's belly should be well 
bathed in olive oil, and wet hot cloths should be kept constant- 
ly on it. He ought to go in the warm bath, and stay there as 
long as he can. 

For the incessant vomiting, I have no other directions to 
give than a successive trial of every article mentioned under 
the head of stomachics. 

Those subject to colic, should be very particular in their di- 
et; avoiding all articles tending to produce flatulency: abstain- 
ing from food to which they are unaccustomed, and from 
liquors containing fixed air. Above all, they should avoid cos- 
tiveness by having regular evacuations from their bowels, 
which can always be done by going to the necessary at stated 
times, and introducing up the anus some slippery body to irri- 
tate the bowels to action. 



325 



DRY BELLY ACHE. 

This is another kind of colic, arising from mineral poisons, 
such as lead. Though somewhat like the common kind, it has 
some peculiarities. It comes on with severe pains about the 
navel, which shoot with great violence from side to side, and 
with convulsive spasms in the bowels and muscles of the belly, 
with a strong tendency to palsy in the lower extremities. The 
pains, from the pit of the stomach, extend downwards towards 
the intestines, particularly around'the navel, accompanied with 
belching, sickness at stomach, obstinate costiveness, a frequent 
but ineffectual desire to evacuate the bowels. After a short 
time, the pains increase in violence; the wholly belly is highly 
painful to the touch, and is contracted into hard and irregular 
knots or lumps, and the bowels are so contracted with spasm 
as .o render it difficult to give a glyster. The retraction of the 
belly, the bent position of the body, and the palsied and droop- 
ing hand, are the characteristics of this colic. 

When the symptoms are so violent as to endanger inflamma- 
tion in the intestines, bleeding will be adviseable, which should 
be done freely, according to the state of the patient. Next hot, 
wet cloths, or other fomentations, should be applied to the bel- 
ly; the general warm bath; large doses of opium, with calomel, 
may be given, to aid in overcoming the spasm. Throwing 
cold water on the belly, has sometimes afforded relief, by ex- 
pediting the operation of the purgatives. When these means 
fail, it is customary to give clysters of laudanum, or tobacco. 
Sometimes a very little of the tincture of tobacco may be taken 
internally. Relief has been obtained by bathing the belly in 
laudanum; and to it I would most strongly recommend the 
application of a decoction of tobacco. As soon as the spasms 
relax, and the stomach is somewhat composed, some mild pur- 
gative medicine should be given, and repeated until it operates. 

Flannel next the skin, and the daily use of the flesh brush 
and bathing in warm water, are good preventives. Alum, in 
doses of fifteen grains, repeated every fourth hour, has been re- 
commended in slight cases. 



328 

In cases of palsy following this disease, when brought on by- 
lead, a mercurial course is recommended. And lunar caustic, 
in doses of one or two grains rubbed up with bread as large as 
a marble, has been frequently given with advantage. 



AFFECTIONS ABOUT THE FUNDAMENT. 

PILES. 

This is a disease which almost every one has at times; vary- 
ing in degree, from moderate inflammation of the fundament^ 
to the formation of tumours. In the beginning, the anus and 
its edges, have their sensibility greatly increased: there is a 
sense of soreness, a feel as if innumerable sharp points were 
perforating the parts. There is generally an increase of the 
secretion of the mucus of the part, erroneously supposed the 
cause of the complaint, as its seat is in the hard parts, the 
fibres and vessels. Sometimes the inflammation increases con- 
siderably, as does the swelling; which often terminates in 
tumours of a dark colour, which bursting, discharge a dark 
blood, that affords present relief. At other times, the pain ex- 
tends up the gut, constituting what is called the blind piles. 
The disease is apt to be attended with fever, and to return at 
intervals. It is sometimes accompanied with an affection of 
the liver, and with such profuse discharges of blood, as to re- 
quire the application of cold water, of lead water, and other 
astringents to arrest it. 

The prevention of this loathsome disease is ensured, as cer- 
tainly as that you exist, by daily washing the fundament in 
cold water, especially after every evacuation from the bowels. 
When, from riding or walking, there appears to be an increas- 
ed feeling in the part, there should be an immediate resort to 
the use of water. I never knew or heard of one person who 
ever had the piles, who took the trouble of using this cleanly 
ablution. 



327 

The cure of piles may generally be effected by the hourly 
application of cold water, made more so by ice; particularly if 
aided by abstinence in eating and drinking, and rest. When 
the disease is considerable, it is best to apply a solution of 
sugar of lead, a tea spoonful to the pint of water, and to keep 
a rag wet with it constantly on the inflamed parts. I have 
seen the most distressing cases of it cured by cold water alone; 
much sooner than by the old modes, with nut galls, alum and 
supposed astringents. In cases attended with fever, you should 
bleed, and purge with salts, oil, or calomel, to be repeated 
until the fever and inflammation subside. 

When the pain is violent, in addition to the iced and 
lead water, sweet oil should be applied: mild mercurial oint- 
ment is also proper. Bathing the part in a watery solution 
of opium, or laudanum and water; setting over a tub of hot 
water, in which there is a heated stone to expedite the genera- 
tion of steam; an ointment of the Jamestown weed, and com- 
mon lead ointment, have generally afforded great relief. When 
the pain is up in the bowels, more evacuations are proper than 
in the other cases; but above all, inject freely, every hour or 
two, cold water. If the pain be great, add two grains of sugar 
of lead to each injection. The disease in those persons who 
have been intemperate, or have any affection of the liver; can 
only be effectually cured, by going through a course of mer- 
cury, or nitric acid. All persons who have had the piles for a 
length of time should be very cautious about their entire sup- 
pression. It should not be done unless the person occasionally 
substitute some other irritation, as an issue, or blister on the 
small of the back. He should live low, take much exercise, 
occasionally a vomit and purge; and always keep the bowels 
open. These are requisite: as the system when quickly de- 
prived of all such powerful irritations, is very apt to be violent- 
ly affected in other parts: ending, as I have known it to do, in 
convulsions apoplexy and sudden death. Proper attention to 
evacuations may save you from much suffering, if not prema- 
ture death. 



328 



WARTS. 

The parts about the fundament are very subject to warts 
or tumours, particularly among those who do not sit daily in 
cold water. When they grow to any considerable size, it is 
best to tie a small string tightly round each at its origin, or to 
cut them off with a sharp pair of scissors. As there is no dan- 
ger in the operation, though painful,) any one may perform 
it. The parts should be bathed in lead water, as above, after 
the operation, and mild mercurial ointment applied to the 
sores until cured. Free washing will prevent the recurrence 
of these tumours. Sometimes these tumours have been dis- 
persed by pouring cold water from a height through a spout 
on the part. Mercurial ointment has also caused their absorp- 
tion, and compression by a ball of cotton covered with sheet 
lead. 



BOILS AND FISTULAS. 

No part of the system is more subject to inflammation than 
the fundament; and when inflamed, to degenerate into fistulas, 
which are running sores through long inflamed passages or 
canals, formed for the passage of matter. The number of men 
and women who daily die in the United States, from neglect- 
ing these affections at their commencement, is in reality almost 
incredible, and should act as a warning to you to avoid the like 
evil. I would have every one affected with the slightest inflam- 
mation in this part, to have in view, until the cure be complet- 
ed, the most distressing termination, in order that in good 
earnest attention be given to the subject. 

These inflammations are certainly to be prevented by fre- 
quent washing in cold water, and daily evacuating the bowels. 

The cure is to be effected by cold applications. An hourly 
application of the coldest water of ice, with abstemious diet, 
and perfect rest, will be sufficient to relieve lesser degrees of 
these affections. But when these remedies have been neglect- 



g£9 

ed, or when the inflammation still increases, the patient should 
be blooded freely, should be cupped near the part, to which 
leeches should be applied; immediately after, rags wet with 
lead water should be applied, and removed every hour or two. 
If this do not prevent the boil from forming matter, (called 
coming to a head, or suppuration) then a poultice may be kept 
on it, of any oily moist article. The moment the matter ap- 
pears to be formed, and coming to a point, it should be lanced, 
cut straight in the direction to the anus, the orifice just large 
enough to allow the passage of the matter. The lancet may 
safely go half an inch deep: needles have been used for these 
boils by some, when the matter appeared to be near the sur- 
face. The best instrument, giving least pain, is the common 
spring lancet, for opening all boils. After the opening, and 
the passage of the matter, a poultice of milk and bread should 
be applied; I have used these made wet with lead water, with 
advantage. It is by subduing the inflammation of these boils, 
by evacuations and cold applications,— remedies which the 
most ignorant can resort to with safety— that the formation 
of fistulas is prevented- The cold washes are to be con- 
tinued some time after the cure, to prevent returns, to which 
the parts are generally much disposed. 



EXCORIATIONS, 

Those taking much exercise, by walking or riding, are very 
apt to have their skin rubbed off, particularly about the buttox 
and thighs. The best remedy I have ever seen tried is cold 
water. It is proper after washing to apply some, oily sub- 
stance ; tallow or hogs' lard answers very well. The moment 
one feels any part increasing in sensibility, the cold water 
should be applied as a preventive; sugar of lead water would 
prove of more service; a little lead ointment, common tallow, 
or suet, are of service in sheathing the part from the irritation 
occasioned by the air on the chaffed part, and so will be starch 
in powder. 

Q q 



330 

INFLAMMATORY SORE THROAT; 
OR, QUINS EY. . 

In this complaint, the parts in and about the throat become 
so inflamed as essentially to interrupt the speech, breathing, 
and swallowing of the patient. Generally the strength of the 
patient is not lessened, as in that of malignant sore throat. 
The swelling, pulse and inflammatory symptoms run high, often 
threatening immediate death from the exclusion of air. 

The causes which usually give rise to it, are exposure to 
cold, either from sudden vicissitudes of weather, from being- 
placed in a partial current of air, wearing damp linen, sitting 
in wet rooms, or getting the feet wet, or coming out of a 
heated and crowded room suddenly into the open and cool air; 
all of which may give a sudden check to perspiration. It may 
also be occasioned by violent exertions of the voice, blowing 
wind instruments, acrid substances irritating the back of the 
throat, and by the suppression of accustomed evacuations. It 
principally attacks the young and those of a full habit: and is 
chiefly confined to cold and changeable climates, occurring 
usually in the spring and autumn. It is never contagious. — 
But in many people there seems to be a particular tendency to 
the disease, as from inconsiderable causes it is often induced. 

An inflammatory sore throat discovers itself by a difficulty 
of swallowing and breathing, accompanied by a redness and 
swelling of the parts on one or each side of the back of 
the throat, by dryness of the mouth, foulness of the tongue, 
pains in the parts, hoarseness of the voice, a frequency of 
attempt, but difficulty, in spitting mucus, and some degree of 
fever. As the disease advances, the difficulty of swallowing and 
breathing become greater, the speech is very indistinct, the 
dryness of the throat and the thirst increase, the tongue swells 
and is covered with a dark fur, and the pulse is full, hard and 
frequent, as in all inflammatory fever. In a few cases, small 
white sloughy spots are to be observed on the parts back of the 



331 

throat, and there is sometimes complete deafness. When these 
symptoms are considerable, the eyes become inflamed and the 
face swelled and florid; breathing is performed with difficulty, 
and the patient is obliged to be supported in nearly an erect 
posture, to prevent suffocation. Delirium and stupefaction 
-sometimes come on. If the inflammation proceeds to such a 
height as to put a total stop to breathing, the face will become 
livid, and the patient quickly die, unless relieved. 

The chief danger arising from this species of quinsey, is the 
swelling, producing suffocation, and preventing a sufficient 
quantity of nourishment from being taken. When proper 
steps are early taken, the inflammatory swelling wUl readily 
go off by absorption or formation of matter. 

When matter is likely to ensue, the parts affected be- 
come more pale and less painful, a sense of pulsation is felt in 
them, and there are slight shiverings. The matter when form- 
ed passes either into the stomach and affords a sudden relief, 
or into the mouth and is spit out of a very clotted appearance, 
often mixed with blood of a nauseating bitter taste, and bad 
smell. The relief experienced by the discharge, is often very 
remarkable from its suddenness; for the person who a few min- 
utes before, was not able to swallow the smallest quantity of 
anything, and who breathed with great difficulty, now feels 
perfect ease, and is able to eat and drink heartily. Sometimes, 
however, the disease does not terminate in this manner; 
but in several small boils, which produce trifling superficial 
sores, being of a white or gray colour, similar to the thrush. 
But when the matter is formed, it ought to be instantly dis- 
charged by opening the part with a lancet: one of the com- 
mon kind will answer if fixed to a longer and steady im- 
moveable handle. 

In the treatment of this complaint, our first and chief endea- 
vour should be to carry off the inflammation; for which, if the 
inflammatory symptoms run high, the pulse be quick and hard, 
and the breathing difficult, copious and repeated bleeding 
should be had recourse to, and cupping, or the application of 
leeches to the throat, particularly on the side most affected. — 
Drawing blood from the parts of the mouth enlarged, by scari- 



33£ 

fications, is likewise a powerful remedy: and, when employed 
with freedom on its first appearance, will greatly lessen the in- 
flammation and prevent the formation of matter. At the be- 
ginning of this disease, and before the fever comes on in great 
degreee, the early giving a vomit often proves extremely use- 
ful, and now and then checks its complete formation. Strong- 
purgatives of calomel and jalap, or salts, should be given, to 
assist in removing the inflammation; and they are to be repeat- 
ed as long as it lasts. 

In cases where the swelling in the throat is considerable, the 
early application of a blister round the throat, and to the back 
of the neck, will be attended with a good effect; but in slight 
cases, it will be sufficient to have these parts rubbed twice or 
thrice a day with volatile linament, or hartshorn; keeping a 
flannel round the throat. 

The mouth and back of the throat, are to be washed with 
lead water, or any of the cooling astringent gargles; gargling 
is the best mode of washing the inside of the throat: but its 
motion is sometimes so painful and irksome, as to prevent the 
patient from having recourse to it. In such cases, the medi- 
cine may be thrown in by means of a syringe. 

Frequently inhaling the vapour arising from boiling water 
mixed with vinegar, throughout the course of the day, will 
greatly assist the effects of gargles. 

I repeat that in this and all affections of the throat, the dan- 
ger is not so much from the nature of the disease, as from the 
risk of suffocation. It therefore calls for the most energetic 
and prompt attention. 



MUMPS. 

This disease chiefly affects children, and is often epidemic 
and contagious. It is distinguished by an external moveable 
swelling, that appears most commonly on both sides of the 
neck, but in seme instances is confined to one. These tumours 
occupy the glands about the throat; are large, hard, and some- 
what painful; and sometimes they attain to such a considerable 



33a 

size, as greatly to impede breathing and swallowing: thereby 
giving rise to fever. The swelling usually increases till the 
fourth day: but then declines, and in a few days goes off entire- 
ly; when the febrile disposition likewise ceases. Sometimes as 
the swelling of the throat subsides, it happens that tumours 
affect the testicles in the male sex, or breasts in the female: but 
these generally go away in a few days. Sometimes the tumour 
in the throat becomes suddenly suppressed, and is not accom- 
panied with the last mentioned symptom; or if so, this is quick- 
ly repressed; when the fever becomes very considerable, and 
occasionally ends in delirium and death. 

In a few instances, where the swelling has been considerable, 
matter has been formed in the parts, and occasioned great de^ 
formity; sometimes it has bursted inside, and discharging its 
contents on the wind-pipe, has suffocated the patient. 

However, there is seldom much danger from this disease: 
and it does not often require the assistance of medicine. Al! 
that is in general requisite, is to keep the head and face warm, 
and to avoid taking cold, and to open the bowels by gentle lax- 
atives of salts and oils. But should the tumour in the neck 
suddenly disappear, and the feverish symptoms increase, so as 
to induce an apprehension that the brain will be affected; it will 
be adviseable to promote and reproduce the swelling, by apply- 
ing warm water, poultices, and the volatile linament, harts- 
horn and the like, to the throat. To prevent the consequences 
that might ensue in this case, bleeding, purging, small doses of 
emetic tartar, with blisters on the breast, are requisite, in pro- 
portion to the violence of the disease. 

When the testicles become much affected and swelled, every 
endeavour should be exerted to prevent the formation of mat- 
ter. You are "to bleed in the arm, or over the testicle to apply 
leeches: to purge freely, and apply to the testicles solutions of 
lead water; a bag or bandage is to be applied, so as to suspend 
the testicles. Similar means are to be pursued when, on a re- 
trocession of the tumours in the neck, the female breast be- 
comes hardened and swelled, endangering the formation of 
matter.. 



334 



PUTRID SORE THROAT. 



The term, putrid may with some propriety be attached to 
this complaint; as the discharge from the sore back of the throat 
is really of a most offensive and putrid nature, sometimes at- 
tended with an actual mortification of the part. It is usually- 
accompanied with a fever of low action, called nervous. It ge- 
nerally comes on with a sense of giddiness and shivering; fol- 
lowed by great heat, attended with pains in the head, soreness 
of the throat, stiffness about the neck, sickness of the stomach, 
with vomiting and occasional delirium. The back parts of 
the throat will be found, on examination, to be swelled; of a 
deep red colour; and sometime after there will be white or ash 
coloured spots, soon terminating in deep, foul sores, in propor- 
tion to the disease. In three or four days, a red eruption is 
generally thrown out, first on the face and neck, then over the 
whole body. 

In the commencement of this affection, if the system be in 
any degree inflammatory, a loss of blood from the arm, at least 
in small quantity, leeches applied to the throat, cupping about 
the neck, then warm flannels, also purgatives, will be proper. 
In general cases, a vomit ought first to be given. Gargles to 
wash the throat, should early be resorted to. Sweet oil alone 
forms an excellent one; a weak solution of sugar of lead is ano- 
ther; also, one of white vitriol, or alum. When the sores are 
formed, a decoction of oak or of Peruvian bark, with or with- 
out a little port or claret wine, are to be substituted. In some 
instances, where this disease has been very prevalent in the 
West Indies and other parts, a strong decoction of red pepper 
has been used with great advantage, even in the case of chil- 
dren. Dr. Thomas, of whose book I have constantly made 
such a free use, speaks highly of a mixture of two table spoons 
of red pepper, with a tea spoon of salt, in half a pint of boiling 
water, to which is to be added as much vinegar; this, after stand- 
ing about half an hour, is to be strained, and two table spoon- 



335 

fuls given in about every half hour. Agargle made of yeast 
and finely powdered charcoal, will prove of great service. 

While steadily keeping in view the condition and the remidies 
for the throat, you must not be less careful of the general state 
of the system. After its inflammatory state, if it did exist, sub- 
sides, fchen it will be of the low, nervous cast; requiring the 
same treatment of tonics, stimulants, purification of bowels, as 
is recommended for low fevers, to which I refer you for tfce 
kind and doses. 



SCARLET FEVER. 

This disease is supposed to be the same as that just describ- 
ed, the putrid sore throat; at least, in some of its varieties, 
there is no difference between the two. However, this is of no 
consequence, as our prescriptions are never for the names of 
diseases, but the state of the body. There is but little ques- 
tion but that it is a contagious disease. It prevails most at the 
close of summer. 

It commences, like most fevers, with chilliness, and irregu- 
larities in the pulse, and breathing with great weakness. It 
is sometimes marked by inflammation of the back of the throat, 
with great soreness, and always there is considerable redness 
in the part. About the fourth day of the disease, the face be- 
comes a little swelled; spots of a florid colour appear over the 
skin, which gradually unite; and about three days more, they 
disappear, and the upper surface of the skin comes off in scales 
of a mealy sort of appearance. It is sometimes followed by a 
slight dropsical swelling on the skin. The disease has a strong 
resemblance to the measles; but differs in the absence of much 
cough; its eruptions are less distinct, and appear on the second 
day, and the skin is of a more vivid red; the eye is not watery, 
and there is no sneezing, or running at the nose, — at least, very 
little. 

In the mild stages of this fever, there is no danger; and it ge^ 
nerally terminates in six or seven days, by the falling of the 
scales from the skin, and a gentle perspiration: and the patient 



336 

is gradually restored to health and strength. But in its more 
malignant forms, it degenerates into the low, nervous fever, and 
is very apt to prove fatal. 

The treatment should be commenced by giving one or two 
vomits on the first and second days of the attack; to be follow- 
ed by keeping the bowels regularly open with small (Joses of 
magnesia, or neutral salts. The patient should be kept in a 
cool and quiet state, and may drink any article of a light kind, 
that is not stimulating; and if his throat be sore, it should be 
gargled with those articles directed for the putrid sore throat. 

In severe cases, when the skin is very hot and dry, the pulse 
much quickened, the head painful, the most speedy and effec- 
tual remedy is the application of cold water to the whole of the 
body. There is no question, from the statement of so many 
respectable physicians, that it is a powerful remedy and ought 
always to be applied. It is recommended to throw several gal- 
lons of the coldest water over the whole body, then wipe it dry 
and return it to bed. Small doses of a solution of tartar, may 
then be given; and generally a perspiration follows, which ter- 
minates the disorder without any discoloration of the skin. — 
When it is inconvenient to have the water thrown on the body, 
cloths dipped in it and applied to the body, or, as it is called, 
sponged all over, will make a good substitute. It is to be re- 
membered, however, that cold applications are improper when 
there is any shivering, and when the system is very much re- 
duced, so that there is no power to react. 

When the fever degenerates completely into the low, nervous 
state, the remedies are the same as in putrid sore throat, to 
which you are referred. — Though I do not think it amiss to re- 
peat — again and again — let your stimulants be of the common 
kind; as wines, porter, toddy, laudanum, and generous diet. — 
Let them be given in moderation. Never let the contents of 
/the. bowels stagnate, nor become offensive; to prevent which, 
have them opened once a day, and give prepared chalk, or 
yeast, with or without charcoal: and always endeavour to re- 
lieve any part appearing particularly affected, by cupping — 
freely and daily repeated. It is infinitely preferable to blisters, 
though they may be often requisite. 



387 



AFFECTIONS OF THE EAR. 

The ear is subject to inflammations, for the most part, with- 
out fever, although the pains of the patient are sometimes 
very great. In some instances., the fever assumes a formida- 
ble appearance; stupefaction, delirium, and convulsions, come 
on, sometimes ending fatally. It is produced by the same cau- 
ses with other inflammations, but by none more readily than 
by exposure of the ear to cold winds. 

In the treatment of this complaint, we should proceed on the 
same principles as in that of common inflammations. While it 
is merely a local affection, local remedies alone are necessary, 
if we except purging for the purpose of cleansing the bowels. 
Local blood-letting by leeches, or cupping behind the ear; then 
a blister on the same place, and flannels out of hot water, are 
to be used. Injections of a weak solution of sugar of lead into 
the ear, will greatly tend to lessen the inflammation; also sweet 
oil, and milk and water. 

If the pain does not abate, but should increase, we may ex- 
pect the formation of matter. When this seems unavoidable, 
we may encourage it by the application of poultices, and warm 
steam or vapour, to the part; and when the abscess bursts, or 
is opened, the ear is to be syringed, from time to time, with 
some mucilaginous liquid, or oil, or milk and water; after 
which, soap and water. 

When inflammation of the ear is accompanied with pain 
diffused over the whole head, fever, delirium, or stupefaction, 
the most powerful remedies are to be resorted to, as free bleed- 
ing, cupping the head, and strong purges, to subdue the in- 
flammatory state of the system. 

The formation of matter is generally the consequence of vio- 
lent inflammation; and then the structure of the whole internal 
ear is apt to be injured; the bones sometimes become destroyed, 
and are discharged through the external hole of the ear, with 
much offensive matter. In these cases, we are to inject into 
the ear yeast, with charcoal powder, and ^stringent washes.*— 



338 

There is a total loss of the sense of hearing in the ear, when 
the bones are discharged. 

Calous holes, or orifices, called fistulas of the internal ear, 
are now and then the consequence of such disease, and prove 
very troublesome. 

Ear-ache sometimes continues many days, without any appa- 
rent inflammation, and is then frequently removed by filling 
the ear with cotton or wool, wetted with laudanum, or ether, or 
with warm oil, or warm water. Sometimes a pain in the ear 
is the consequence of association with a diseased tooth, in 
which case, the ether should be applied to the cheek, the sus- 
pected tooth extracted, or a grain of opium, with a little cam- 
phor, be applied to the tooth. When insects get into the ear, 
they may be destroyed by blowing in the smoke of tobacco, or 
dropping in sweet oil. t 

Deafness may arise from many causes besides destruction of 
the ear from inflammation. Sometimes it arises from obstruc- 
tion of the tube leading from the mouth to the ear; in which 
case, a surgeon alone can relieve by using injections in the part 
with a syringe of a particular structure. But the most frequent 
cause is- the induration of the wax of the ear. This is to be re- 
moved by syringing the ear frequently with casteel soap and 
water, and then filling it occasionally with olive oil. Sulphuric 
ether has been found very effectual in dissolving the wax. The 
best article I ever used, was a drachm of muriatic acid in a 
pint of water: If it smart, it should be further diluted. The 
nitric acid, equally diluted, has also been used with advantage. 
After any injections, the ear should be kept filled with wool 
or cotton. — Common salt and water, have been recommended. 



TOOTH-ACH 

Is an acute pain in one or more of the teeth; but most general- 
ly originates in one, and from that is extended to the adjacent 
parts. A decay of the tooth .itself, different irritating sub- 
stances, as the application of cold, or some acrid matter; ii 
the most usual cause of the complaint. But in some cases 



339 

it would seem to proceed from a rheumatic affection of the 
muscles and membranes of the jaw: and here the whole side 
of the face will be affected. When it takes place in pregnan- 
cy, it is to be considered as arising either from an increased 
irritability, or from sympathy. 

The acrid matter producing tooth-ach, probably originates 
in the tooth itself; as it frequently operates without any exter- 
nal injury to the tooth. But very frequently the decay appears 
first upon the external surface or enamel of the tooth, in one or 
more superficial spots. The caries, or decay, by spreading and 
corroding deeper, at length penetrates the substance of the 
tooth; and the external air, and other matter, getting into the 
cavity, stimulate the nerve, and thereby excite the tooth-ach. 
The most effectual remedy for this disease, is extraction of 
the decayed tooth; but as this, in some cases, may not be ad- 
viseable, and in others is objected to by the patient, it will ofr 
ten be necessary to substitute palliative means. 

To relieve the violence of the pain, where there is a hollow 
in the diseased tooth, cotton impregnated with substances of a 
caustic nature, such as the essential oil of cloves, cajeput, nut- 
meg, &c. also with sulphuric or other mineral acids, or a 
small pill composed of opium and camphor. In some instan- 
ces, burning with a hot iron has been used, to destoy the sensi- 
bility of the nerve. To prevent a return of the pain, when it 
has ceased, the hole in the tooth should be widened within by 
by a proper instrument, and then stopped with leaf gold; by 
which operation, it may often be preserved for many years 
without any further inconvenience to the person. Common 
white wax will often serve as a temporary remedy. 

These are the remedies to be used when the disease is confin- 
ed to a single tooth; but when the neighbouring parts become 
affected, or there is no access for such an application to the 
nerve, an irritation is to be excited by means of blisters behind 
the years, or by rubbing the jaws with those linaments which 
induce a redness on the skin without blistering; afterwards 
keeping the part warm with flannel, has often afforded much 
relief in cases where the pain was diffused. The applica< 



340 

tion of steam, of olive oil, and of cloths from hot water, 
will prove of service. \ 

In those rheumatic affections of the jaws, to which many 
persons are subject, and in which the pain is not confined to 
one tooth, but occupies the whole face, it has been found of ser- 
vice to excite sneezing and a free discharge of spittle, by chew- 
ing horse-radish, tobacco, or any thing that will produce the 
effect of increasing the discharge from the glands of the mouth. 
I would try a momentary salivation, by taking the dose of mer- 
cury in spirit, as prescribed for those bit by mad dogs. A de- 
coction of the Jamestown weed, rubbed over the jaw, and held 
in the mouth, I have known serviceable; as also, a watery solu- 
tion of opium. Powdered charcoal is the best tooth powder, 
as I have before stated on the subject of the teeth; and as it 
tends to lessen the decay of the teeth, as well as to correct all 
their offensive matter, it is incumbent on those who have hol- 
low teeth to use it freely. 

I conclude this subject with the precaution, that, when the 
teeth are sound, it is improper in general to extract one be- 
cause it aches; for in most cases, the extraction will be* follow- 
ed by the pain of the next tooth, and soon. The affection, in 
these cases, should be treated as an inflammatory affection of a 
local nature; cupping, and blisters, Sec. opposite. And I renew 
the advice given under the head of purification of the mouth, 
to have decayed teeth extracted; because they act as irritating 
matter in the sensible parts of the mouth, producing disorders 
very analagous to those of the secondary effects of pox. 



INDIGESTION. 

This is a complaint which attacks occasionally, in greater 
or lesser degrees, most persons. The difficulties of indigestion 
are complained of as universally as the subject of digestible 
food is discussed. Indigestion of greatest degrees, is sometimes 
marked by sickness of stomach, vomiting, and excessive flatu- 
lence: also, heart-burn, hiccup, waterbrash, acidity, head- 



341 

ach, lassitude, unhealthy complexion, bad sleep, high coloured 
urine, See. Some modifications of this disease are attended 
with vomiting of blood or of bile; severe pain in the stomach, 
or are connected with uneasiness in the right side; bloody co- 
loured urine, pain in the top of the shoulder, yellow complex- 
ion, repeated fits of vomiting, &c: in short, by all the symp- 
toms of diseased liver, of which it is sometimes a symptom. 
When the liver is affected, the best medical men should be 
consulted, and should superintend the salivation of the patient, 
which affords the only chance of cure, with a course of nitric 
acid. 

Lesser degrees of indigestion arising from sedentary life, occur 
to those of costive habits, too lazy to take the trouble to evacu- 
ate the bowels every day. Persons who eat irregularly large 
quantities of articles they are unaccustomed to, drink immo- 
derate stimulants, or eat them as in spices, are subject to seri- 
ous degrees of this disease; as also those who have rotten teeth. 

The cure will, in most cases, be perfected by avoiding the 
causes. When it is not, it will be best to consult a physician. 
Costiveness and a sedentary life are easily to be avoided. The 
general health is particularly to be promoted by rubbing the 
skin with the brush, and wearing coarse flannels in contact 
with it and by the salt bath. Lastly, but not of least conse- 
quence, is the diet. 

To determine what is the best article of diet, what the most 
healthy food, although talked of by every body, is a most diffi- 
cult task. Indeed, the most extensive observation leads to the 
conclusion, that there is no diet, healthy or unhealthy, but that 
all depends on our habit of using the particular kind. It is 
habit that familiarizes the stomach to the digestion of each 
article; and it is inattention to this habit, indulging in sudden 
changes from one to another diet, that has induced so many 
persons to pronounce so many articles unhealthy. 

As soon as there is the least reason for believing the stomach 
to be disordered in its digestion, it becomes the patient to ob- 
serve the greatest regularity in eating, as to time and kind. 
The most simple food, and that of which most has been eaten 
during life, should be selected. When it is necessary to 



34& 

change, be sure to change most gradually, taking at first but a 
mouthful daily for several days previous to changing altoge- 
ther. The propriety of this is confirmed by the sickness so 
generally produced in spring seasons, when the food is chang- 
ed. Nothing more shows this than the nausea so generally 
felt after eating fish the first time; and similar are the effects 
produced by eating large quantities of any new fruit. Although 
we may not be sensible of it, in our common changes, neverthe- 
less, very considerable effects are produced in the stomach by 
all variations in diet. Instead, therefore, of deceiving you, as 
some physicians often do, by advising you to confine your- 
selves to veal, fish, pork, or fowl, that they may gain reputa- 
tion by the fancied skill displayed in the selections, I state the 
truth, that the good effects arise from the confinement; and 
that, in all human probability, one kind of meat, one sound 
article, is precisely as good -as another. To this I will add, 
that rest after eating greatly facilitates digestion. 

When the eructations from the stomach are very acid, chalk 
and magnesia, or a quarter of a tea spoonful of potash, or of 
soda mixed in milk or water, may be taken two or three times 
a day. When the stomach has been destroyed by the opera- 
tion of strong stimulants, as spices, drams, opium, or strong 
tea, it is necessary to substitute, in lesser degrees, other stimu- 
lants to promote digestion, different from those which have 
been freely used. Iron, in a state of rust, is highly recom- 
mended: Indeed you had better try in succession all the articles, 
under the head of tonics and stomachics. The quantities or 
proportion must be regulated by previous habits, and should, 
with those who desire to be restored to health, be gradually 
discontinued altogether, 



SPRAINS. 

These are over-stretching or straining of the parts about the 
joints, arising from sudden or violent exertions, the slipping of 
the feet, or a fall. They most commonly affect the wrists, an- 
kles and knees. They are followed by violent pain at the 



348 

instant, and then swelling and inflammation. There is gener- 
ally a rupture of the blood-vessels within, and consequently an 
effusion of blood. The skin is not discoloured for some hours: 
after which it generally becomes of a dark blueish or red co- 
lour: increasing or disappearing from the inflammatory state 
in proportion to the extent of injury. 

Fortunately the best remedy for lessening the effects of a 
sprain, is that nearest at hand, cold water. As soon as the 
accident happens, the part should be plunged in cold water, as 
a few pitchers of cold water poured over it. The next reme- 
dy is rest, perfect rest: t^e part being kept rather elevated, 
never hanging dow r n. The cold applications stop the effusion 
of blood, and promote its absorption: the elevation of the part 
retards the passage of blood to it. It is customary to apply 
brown paper, (rags are as good,) wet with vinegar, or brandy 
and water to the part, and continue them wet on the part, for 
several days. Two or three drachms of crude sal ammoniac 
in a pint of water, is probably of superior efficacy. Spirits of 
camphor, or that preparation of it, called opodeldoc, may with 
advantage be rubbed over the part: and it should gently be 
daily rubbed with the hand or a ball of cotton. 

If inflammation comes on the part, depend upon it, you can- 
not pay too great attention to remove it. You must bleed if 
there be fever, purge freely, live low, and make and continue 
cool applications of lead water. Leeches on the spot, most in- 
flamed, will do great good, and so will cupping near it. If the 
part be much distended and painful, poultices at night of flax- 
seed, or elem bark, will aid in removing it. But if you will 
have patience in the first instance to confine yourself and fol- 
low the first directions, you will probably never have need of 
other advice. But if you do not, let me warn you that from 
very trivial accidents of this nature, the neglect of the precau- 
tions has been followed by a loss of the joint, by stiffness, by 
decay of the bone, and loss of the limb in consequence. 

When pains, or numbness, remain after the sprained part is 
otherwise relieved, the pouring of water on it from an elevated 
spout, and frequently rubbing it with camphorated spirits, vo- 




344 

latile alkali, and the like articles, will expedite the entire 
recovery. 



BRUISES AND BRUISED WOUNDS. 

The frequency of the occurrence of these, and the abomina- 
ble ignorance with which they are generally treated through- 
out the country, render this subject of no doubtful importance. 
A blow or knock on our flesh, producing what is called a bruise, 
is attended by the bursting of blood-vessels underneath the 
skin, and a consequent effusion of blood, producing more or 
less of a lump called tumour. It is often accompanied with 
tearing of the skin, constituting a wound. As in sprains, the 
first and best application is cold water. Let rags from the 
coldest water be instantly applied and kept on the part, whe- 
ther the skin be wounded or not. The cold contracts the ves- 
sels, and prevents the effusion of blood. Cold metallic bodies, 
as a silver or iron spoon, or scraped potatoes and turnips, and 
the like, will answer. To promote the absorption of whatever 
blood may be effused, vinegar, or spirit and water, or a weak 
solution of crude sal ammoniac, occasionally applied, will prove 
sufficient in almost every case. But when considerable tumours 
are formed, and such treatment does not disperse them, and 
if inflammation comes on; poultices and lead water are to be 
used, as is commonly done for boils. As in sprains, the 
more comfortably cool, quiet, and elevated the part is kept, 
the better. 

When matter is formed in these tumours, or the blood in 
them remains fluid, it is best to open them early, and give vent 
to their contents. 

When there is a slight wound of the skin, all we have to do, 
is to exclude the air, which will be sufficiently well done by a 
plaster of tallow, suet, hogs' lard, or best by lead ointment.— 
But when tearing or laceration of the parts is considerable, we 
have to encounter inflammation sometimes of an alarming ex- 
tent, ending in mortification Gun-shot wounds are those of 
this kind most frequently occurring. Need I mention that in 



343 

all cases where any foreign body is found in a wound, it should 
be carefully removed? The advice I have to give, is compris- 
ed in this: Do nothing to increase inflammation, and do all 
you can reasonably to prevent it. Let the diet and drinks be 
of the mildest kind, and keep the parts without heat and at rest, 
for the first object. For the second, let the evacuations by the 
lancet and purging be in proportion to the degree of inflamma- 
tion. When the inflammation is violent, local blood-letting by 
leeches or cupping, will be proper: poultices of lead water no 
less so. When the pain is violent, soothing applications of 
oily poultices, of flax seed, elm bark, and the like, should be 
applied and frequently removed. Bathing the part with olive 
oil and a warm watery solution of opium, will often lessen the 
irritation. 

When matter is formed, its discharge s to be encouraged 
by common warm poultices until the inflammation subsides; 
and that taking place, the part is to be treated as a simple sore, 
the main point in doing which, is to exclude the air with plas- 
ters of the mildest ointments. 

I have one most important precaution to give to those meet- 
ing with wounds of this nature. It is, never — never be, or, 
much less, sleep, exposed to a current of wind. Of nothing am 
I more convinced than that such exposures are the chief cause 
of that horrible affliction called the Lock Jaw. Every case of 
this disease I have seen, could be traced to this cause: not that 
it is the sole cause of it; but you will admit that it must have 
great influence, when you advert to its effects in producing the 
spasm of the muscles of one side of the neck, called the wry 
neck, which so frequently happens when one sleeps under an 
open window, with the wind blowing on the part. Its effects 
must be more powerful when the system is in the irritable state 
produced by bruised or lacerated wounds. 



OF PUNCTURED WOUNDS. 

These in general require no other treatment than the extrac- 
tion of any foreign substance that may be left in them, when it 
S s 



346 

can be easily done: and to lessen the chance of inflammation by 
keeping a warm poultice on them, to preserve the surface re- 
laxed, and facilitate the discharge of any matter which may be 
formed at the bottom of the puncture. When inflammation is 
threatened, the means to prevent and lessen it, pointed out un- 
der the last head, should be pursued. 

These wounds sometimes end in convulsions of the muscles, 
and are most apt to be followed by lock jaw. Sometimes it is 

found necessary to dilate the wound and fully divide any nerve 

» 

or tendon which may have been punctured; sometimes a blister 
over the part has succeeded without the division. 



OF WOUNDS FROM CUTS. 

These are called incised wounds; generally proceeding from 
the incision of some edged instrument, as knives, scythes, 8cc, 
and accompanied with more or less loss of blood; the division 
and the separation of more or less flesh. 

The first object we have in view, is to stop the bleeding; the 
second is to save as much flesh as we can, for a speedy union; 
and the third is to regulate the inflammation ensuing to the 
best advantage. 

If the bleeding be from small vessels, it need not be regard- 
ed; a little cold water will speedily stop it. If it be from a 
large artery, (and of course dangerous,) which will be shewn 
by the jets, or sudden spouts of the blood, it is instantly to be 
stopped, either by the continued pressure of the hand of some 
one, or by tying a band or rope around the limb, and twisting 
it till the bleeding ceases. If a surgeon can be procured di- 
rectly, in the name of common sense, you are to lose no time 
in procuring one; but if he cannot be procured in two or three 
hours, other steps must be taken. If a surgeon's needle and 
thread cannot be procured to take up the artery, a substitute 
must be tried: you can make, of the toughest hickory wood, a 
pair of forceps — an instrument like the tongs used to curl 
hair, and well fastened together at the joint. On wiping the 
wound, and seeing the bleeding vessel, these can be applied to 



347 

it, compressed together, and tied, so as -to remain squeezing 
the sides of the bleeding vessel. I speak of this only as a sub- 
stitute, which I am sure any active, attentive attendant, can 
carry into execution. If not this, then cram the wound full of 
powdered charcoal, which will coagulate the blood; then bind 
up the wound moderately tight, and unloose the cord or band, 
or the limb will mortify. If not, make a little bolster, of cork 
or stiffly quilted rags, to press on the bleeding artery; it is not 
to be larger than the wound to which it is to be applied, and 
it is to project outwards an inch or two: then, for the opposite 
side of the limb, make another bolster, which is to be laid with 
the length of the limb; a piece of plank, broader than the limb 
is wide, is to be put on this, and a bandage applied around and 
over it, and the bolster on the artery. The consequence will 
be, compression on these two opposite parts only, so that the 
circulation of the limb can go on at each of the sides. Imper- 
fect as are such substitutes, they would save many lives in the 
country, if resorted to, until surgeons could be obtained. 

For the second object, of saving as much flesh as we can, we 
must cleanse the parts; and although adhering ever so little to- 
gether, they must be restored to their natural position, and 
kept there by plasters or stitches. 

The propriety of strictly attending to this direction, is daily 
established. You would not believe — it is scarcely credible 
when one sees it — what portions of the covering of our skulls, 
what parts of the body, have been cut off, so as to hang only, as 
it were, by a thread; which parts, when replaced, have united 
to their adjoining parts, leaving only very slight marks behind. 
The resources of nature are always wonderful; but I think ne- 
ver more so, than in the restoration of such divided parts. — 
You are, therefore, to take care never to cut off any part of the 
body, hanging to another part, without giving it a chance of 
reunion to the sound parts. These parts are to be well cleans- 
ed by washing with warm water, and the edges reinstated as 
well as practicable. It is best to keep them so, by slips of stick- 
ing plaster, when they will answer; to apply these, they are 
warmed first, and on making one end stick on one side of the 
wound, the other end is to be carried over to the other side, 



848 

while the edges of the wound are pressed closely together; and 
there is to be as many of these as will cover the wound, ex- 
cepting every inch, where a little opening is to be left for the 
passage of matter which may form. 

The next mode is sewing up the wound. This is described, 
in technical nonsense, — making sutures, in various ways. The 
plain English is: take a needle full of strong, double, twisted, 
and waxed thread, with a common coarse needle at each end; 
push each needle through at opposite sides; best done by push- 
ing, not on the top of the skin down, but underneath the skin 
upwards; draw each needle through, and tie the thread so as to 
bring the edges of the wound together. Stitches of this kind 
are to be made the length of the wound, each about an inch 
apart; and then the whole is to be covered with a plaster of 
simple or lead ointment, or tallow, or hog's lard, in order to 
exclude the air from the wound; which is lightly to be bound 
up, and left at rest for three or four days. The wound at this 
time is to be examined, and new dressings applied. It not un- 
frequently is found united, or what is called healed by the first 
intention: but if not, matter is formed, and the wound is to be 
cleansed and treated as a simple sore; that is, in the most sim- 
ple manner possible; every application to be mild; nothing irri- 
tating. 

But sometimes it happens that the w r ound, instead of form- 
ing matter, takes on the most violent inflammation; pain and 
great fever attend; and there is danger of what is called morti- 
fication. In such cases, we .have to exert every means to retard 
this inflammation. You must bleed and purge in proportion 
to the violence of the action and strength of the subject. Bleed- 
ing near the part by cupping and leeches, cold and even ice 
water, and applications of lead water, frequently renewed, are 
to be tried; but occasionally warm poultices of flax seed, of 
slippery elm bark, or any other mucilage, are found readily to 
allay the irritation. 

Sometimes it happens that no efforts can prevent the ter- 
mination in mortification. The symptoms of this are, the ces- 
sation suddenly of pain, the formation of blisters, a dark ap- 
pearance, and a subsidence of the hardness and swelling of the 



349 

part. If the inflammation still continue, we must still continue 
the cooling applications, and do so until they subside. Some- 
times the mortification extends, and it seems as if it would 
have no limits. Various modes of treating the wound, to ar- 
rest this state, have been recommended; but the best is that 
recommended by Dr. Physic, of Philadelphia: it is to apply a 
blister around all the mortifying edge, to extend one or two 
inches over or on the sound parts. The whole of the morti- 
fied part is to be covered with a poultice, in which charcoal 
is to be the principal ingredient; common Indian meal, made 
into dough, with yeast, is to be mixed w th the powdered coaI> 
and applied to the mortified part. It tends to arrest the putre- 
faction, and to correct the discharges so offensive to the smell. 
When the mortification ceases, nature causes the separation of 
the sound parts; and the unsound are to be removed as they 
are detached. The sores are to be treated as those of the com- 
mon kind; and the state of the patient must decide whether 
his system is to be further evacuated, or to be stimulated. 

During warm weather, especially, these wounds are very 
apt to have in them a great many maggots. Whenever they 
appear, they can be immediately destroyed by a wash made of 
nitric acid and water; about one drachm to the pint of water. 
If it smart, more water can be added. Under any circumstan- 
ces, the utmost cleanliness ought to be observed; for, really, 
the acrid, putrefying matter, tends to irritate the wound, and 
retard the healing. 

All wounds forming matter, ought to be daily washed with 
weak soap-suds. The parts affected should &t least occasion- 
ally be so placed, that the matter may run out, instead of its 
stagnating in them. Whenever it smells offensive, they should 
be sprinkled with fine charcoal. It is said that a weak solu- 
tion of nitric acid, has a similar effect in correcting the offen- 
sive discharges. 

Wounds of the head always require more attention, in pro- 
portion to their extent, than those of other parts. Their con- 
tiguity to the brain is such, that not unfrequently those of a 
very trivial nature cause the inflammation of the brain and for- 
mation of matter under the skull. I mention this fact, in the 



350 

hope that it will induce you to remember the caution, that alter 
all such accidents, the patient ought to do nothing to excite in-> 
flammation; he ought to live very low, and to take an occasional 
purgative, to guard against the excitement of the brain. It 
will be useless for me to give any directions about the treat- 
ment when the skull is fractured, as surely you will apply at 
once to a surgeon. But I will add, that sometimes there is an 
appearance of depression, when there is none; it arising from 
the edges of the blow becoming elevated and leaving a hollow 
within them. 

I have stated that these wounds, after the bleeding had sub- 
sided or was stopt; after all foreign bodies were removed, and 
after their edges were brought and kept together, were to be 
treated as simple sores, if they did not at first heal, but inflam- 
ed and formed matter. Let me again impress upon you, that 
rest is indispensably necessary for the healing of a wound. A 
sore or wound on a joint has been known to continue for years, 
when the part was allowed to be moved: but perfectly healed 
in a few days, when the joint was straitened and kept so by 
splints. Hence this should always be done when the sore is 
on a joint. Next to rest, you have to exclude the air, which 
always tends to irritate and inflame. To do this, the applica- 
tion of simple ointment, tallow, lard and bees' wax, are suffici- 
ent. To expedite the healing, the greatest improvement ever 
made for the object, is to apply slips of adhesive plaster, about 
the width of an inch, in the way recommended for keeping to- 
gether divided parts. Let one end of the plaster be stuck about 
four or six inches on one side, and there held, while the other 
end is carried over and stuck to the other side, so that it shall 
pass over the sore: press down the growing fleshy fibres, called 
granulations, and bring them closer together, so that they may 
unite. , These slips of adhesive plaster, called Baintons slips, 
were first applied by a gentleman of that name, and are unques- 
tionably the most useful applications ever made to simple sores. 
In addition to their enabling you to expedite the healing of 
sores, they should teach you the folly of ever undertaking to 
put any thing between the edges of wounds, to keep them 
apart, or cramming up, or distending, deep wouncis with any 



351 

trash, instead of letting the sides come together for speedy 
reunion. 



WOUNDS OF THE JOINTS. 

In these, as in all wounds penetrating cavities, it is of great 
importance to guard against inflammation: as the effects of it, 
when violent, are very destructive to the constitution. 

In all cases of wounded joints, it is important to place the 
limb in such a posture as to favour the union of the sides of the 
wound, in order to prevent the admission of air, which seldom 
fails to produce general irritation. Not only absolute rest is to 
be enjoined, but a very low diet, with slight laxatives. The 
parts should always, when practicable, be brought together, and 
kept so by slips of adhesive plaster, in preference to sewing 
them up: and when they are to be stiched, the needle should 
only pass through the skin, and never to enter the cavity of the 
joint, where they would increase the inflammation. Treated in 
this way, they very generally speedily unite without inflam- 
mation. 

When inflammation comes on, in consequence of the wound, 
the constitution suffers severely: fever comes on, generally ush- 
ered in with great sickness of stomach; violent pain takes place 
in the joint; and there is an increased secretion of the liquid of 
the part, called synovia, and it is more watery than usual: the 
adjoining bands, called ligaments, enlarge; matter is form- 
ed in all parts of the joint; sores, called ulcers, are formed, fol- 
lowed by openings in various parts of the skin covering the 
joint. Inflammation of this sort, in the joints of the thigh and 
knee and ankle, never takes place without great danger, extreme 
pain, and frequently death. 

When the inflammation does not terminate so speedily, the 
bone becomes inflamed, decays, and exfoliates or separates, and 
the joint becomes fixed, or, in other words, immoveable; the 
patient suffering a tedious, long, and painful confinement, under 
which the constitution often sinks — and a lingering death con- 
cludes the sufferings, These terrible consequences sometimes 



result from simple cuts, or punctures; and are only to be pre- 
vented by an energetic application of the remedies enumerated 
to subdue inflammation — to be extended as far as the patient's 
strength will permit. Local bleeding, by cupping or leeches, 
is to be employed freely; and Dr. Dorsey further recommends 
a blister over the whole joint, to be applied earlier than is re- 
commended by others. He further says, that from whatever 
causes the continued inflammation of the parts arise, the re- 
peated use of blisters is never to be omitted. 

In order more effectually to procure absolute rest of the 
joints, it is necessary to apply splints to fit the parts; which be- 
ing lined with soft materials, occasion no inconvenience. In 
wounds of the knee, ankle or elbow., these splints are indispen- 
sably necessary. When there is reason to apprehend a stiff 
joint, it is necessary to choose the position of the limb in which 
the stiffness will be least inconvenient to the patient, and to 
preserve that posture during the cure. If, for example, the 
elbow were to heal with the arm permanently extended, the 
limb would be almost useless; whereas an arm bent at the el- 
bow, may be useful. — And the reverse in the knee; as an ex- 
tended leg would favour walking. 



WOUNDS OF THE NERVES, TENDONS, AND VEINS. 

The first symptom indicating a wound of a considerable 
nerve, is severe pain, and afterwards a numbness or diminution 
in the sensation and powers of the part to which the injured 
nerve went. These in general gradually subside, and no parti- 
cularly bad consequence results from the wound. 

The tendons (called sinews) when wounded, occasion no 
pain. In. healthy state, they possess no sensibility; though are 
exquisitely sensible when inflamed. These wounds are to be 
treated as wounds in other parts; by keeping them at rest, with 
their divided surfaces in contact. It happens to carpenters and 
ship-joiners, occasionally to divide with a foot adze the great 
tendons connecting the heel to the calf of the leg, (tendo 
Achilles). 



353 

When this accident happens, the foot is to be extended by 
means of a splint extending from the toe to the knee: the divid- 
ed surfaces of the tendon are to be accurately placed in con- 
tact and kept so six or eight weeks, when union will be effect- 
ed : but the patient should not attempt supporting the weight 
of his body on the limb for several months. The same mode 
of treatment is necessary in cases of rupture of the tendon; and 
if folds of the skin get between the ends, they are to be pulled 
out, and kept so by means of adhesive plaster. When parts of 
the calf of the leg rupture, there is generally severe pain and 
effusion of blood. The treatment is the same : and a roller 
should be applied around the leg. 

Wounds of the veins are sometimes followed by inflammation 
and matter is formed within the vein ; and being carried to the 
blood and heart, is apt to occasion death ; in many instances 
preceded by violent fever, and formation of boils or abscesses in 
the course of the vein. The fever should be treated by evacu- 
ations and low diet: but on the vein Dr. Physic recommends 
the application of a blister over the orifice, and extending three 
or four inches around it in all directions. This remedy has 
been found unquestionably the most successful ever used in 
such cases. # 



WHITLOW. 

This is a very painful and distressing inflammation, seated 
at the end of a linger or thumb, generally terminating in the 
formation of matter. The inflammation appears in different 
parts; either at the root or side of the nail; or near the end of 
the finger, or underneath the whole of the soft parts; or under- 
neath the immediate covering of the bone, and the bone itself. 
The most distressing kind is that where the tendinous parts 
are affected, and the inflammation extends along the hand, up 
the arm; sometimes rendering amputation necessary. 

In the treatment of this affection, we should act with an en- 
ergy proportionate to the degree of disease. In all cases of 
fever, blood-letting, particularly by leeches, from the part, 
T t 



354 

purges and low diet, should be enjoined. In common cases, 
repeatedly scalding the finger by suddenly dipping it in boiling 
water, proves sufficient. It is much better to use the strongest 
lye, than water, for this purpose. A blistering plaster of strong 
ointment, should be applied around the whole finger, in order 
to excite action on the surface, to relieve that underneath; and 
it ought to be kept continually discharging. When matter is 
formed under the nail, Dr. Dorsey recommends the nail to be 
scraped away over it, aud a small puncture made for letting it 
out. Whenever there is reason to believe that matter is form- 
ed in any part, by all means, freely cut down to it, and give 
vent to it. Immediate relief from pain will be had, and an end 
be put to the danger of prolonged, distressing, and dangerous 
inflammation: for the subsidence of the inflammation and heal- 
ing of the part are very rapid; whereas when the parts burst, 
as in common boils, these operations are very tedious and pain- 
ful. In my practice, I have never had a case of extended in- 
flammation, because very early I learnt Dr. Physic's important 
directions for preventing it — by free evacuations; but above all, 
by relieving disease within by exciting it without, by scalding 
and blistering the skin to the greatest extent. 



WARTS AND CORNS. 

These are generally situated in the hands and feet, and are a 
Sort of excrescence composed of fibres arising from the part 
below the upper skin. When irritated, they are apt to bleed 
and become sore. 

The best mode of treating them, is to stimulate them by ap- 
plying a strong tincture of Spanish flies, the strongest vinegar, 
caustic volatile alkali, a strong solution in water of corrosive 
sublimate with double the quantity of crude sal ammoniac, blue 
vitriol; and these failing, you must apply lunar caustic, the sul- 
phuric or nitric acid. 

Corns consist in the thickening and hardening of the skiu 
generally about the joints of the toes, and are the result of the 
compression from wearing tight shoes. They are to be reliev- 



355 

ed by wearing loose shoes; by applying pieces of leather spread 
with adhesive plaster, and with holes cut in them of the size of 
the corn. These are put on the part; and the corn being unco- 
vered, is not compressed, as the shoe touches only the sur- 
rounding plaster. Mr. S. Cooper states that a corn may infal- 
libly be cured by the following method: — The corn is to be 
rubbed twice a day with some soft, mild ointment, and then to 
be covered with a soft plaster. Every morning and evening, 
the foot is to be put for half an hour in warm water, and while 
there the corn is to be well rubbed with soap; afterwards all the 
white pulpy outside is to be scraped off, taking care to give no 
pain. This treatment is to be continued without interruption, 
until the corn is totally extirpated, which generally happens in 
ten or twelve days. 



THE INVERTED TOE NAIL. 

This arises generally from wearing tight shoes, and is at- 
tended with severe pain and inflammation: and is sometimes 
followed by sores, and the formation of flesh so tender as to 
render walking impracticable. Sometimes in less degrees of 
this affection, it has been relieved by daily bending the edge of 
the nale upwards, by introducing a small probe underneath the 
depressed lower part and bending it upwards, while with some 
large probe or body the upper part of the nail is held in its 
place. But Dr. Dorsey recommends an entire cutting cut of 
the nail; for which, of course, you will apply to a surgeon. 



OF BODIES LODGED IN THE THROAT. 

Pins, peach stones, fish bones, and other hard bodies, are not 
unfrequently lodged in the throat, and require immediate at- 
tention. 

To extract substances from the gullet, called oesophagus, the 
fingers and forceps are generally the only instruments which, 
can be employed. Frequently by pressing down the tongue 



356 

•with the handle of a spoon, the foreign substance may be seen. 
Whether seen or felt, the finger or forceps may be forced 
around it, so that it may be pulled out. Sometimes a wire, 
with a curve or hook at one end, may be pushed down the 
throat: and then by turning it as it is drawn out, the body may 
be extracted. When this fails, it is recommended to introduce 
down the throat, beyond the foreign body, a piece of compres- 
sed sponge, about the size of a chesnut, well secured to a cord; 
water is then to be poured down the throat, which will distend 
the sponge, which is then to be extracted, and may bring with 
it the body desired to be removed. Next to this, a flexible 
piece of whale bone, called a brobarig, or a smooth split of white 
oak, may be tried; to the end of it a bunch of thread, doubled 
so as to make an immense number of nooses, is fastened: and 
it is pushed down the throat and withdrawn. Little bodies 
may frequently become entangled, and be extracted in this way. 

When the matter cannot be extracted, it becomes necessary to 
push it forcibly into the stomach. This is sometimes effected 
by swallowing a large bolus of bread; but generally by a piece 
of sponge, or ball of cotton, fastened to the end of a flexible 
piece of whale bone or wood. 

Mr. Bell says that the difficulty of swallowing arises in these 
cases as much from the irritation produced by the body, as 
from the bulk of the body. Dr. Physic has therefore recom- 
mended keeping a strong solution of tartar emetic in the mouth, 
to excite relaxation of the parts, and thereby has afforded great 
relief. 



FROSTBITTEN PARTS. 

Among the negroes and the poor, accidents of this nature 
are not uncommon. In such cases, as in warming the body, to 
avoid aching, the restoration to heat must be very gradual: a 
limb has been frozen perfectly stiff, and by being rubbed in 
snow, afterwards in cold water, and very slowly warmed, 
its life has been preserved. The sudden application of heat 
never fails to occasion inflammation, and mortification quickly 



357 

follows. When the heat has been gradually restored, and ac- 
tion and sensation are perceived, the part should be rubbed 
with spirit, the patient be put to bed and kept comfortable: 
perspiration excited by warm drinks, and by enjoining perfect 
rest until the effects subside 

Dr. Dorsey further states, that when mortification occurs, a 
blister is to be applied to its edges, to hasten the separation of 
the dead from the living part; and the sores are to be dressed 
with basilicum ointment, rendered more stimulating by mix- 
ture with the oil of turpentine. 



CHILBLAINS. 

This is a local inflammation, situated generally upon the 
heels, toes, and fingers: but sometime^ on the nose and ears; 
arising from exposure to cold. It varies in degree; when mo- 
derate, a redness is observable upon the skin, attended with 
heat and itching — In greater degree, the part swells, becomes 
of a deeper red colour— sometimes purple or dark blue; the 
heat, itching, and pain are very great. Sometimes small blis- 
ters arise, which burst and end in sores — even in mortification. 

It is the sudden and great changes in the temperature of the 
air that produce chilblains. They occur oftenest in persons 
accustomed to indulgence — in women and children. The sub- 
stitute of thin for thick shoes, is probably the most frequent 
cause of those on the feet. 

They generally make their appearance in the winter; disap- 
pear during the summer, and return the succeeding winter. — 
Some persons suffer most in the fall: others in the spring; and 
their duration is from weeks to months. 

To prevent their formation, the feet should be bathed every 
morning in cold water: and when the feet are cold and damp, 
they should never be held near the fire; nor when very warm, 
be allowed suddenly to get cold. 

The remedies, Dr. Dorsey states, (most accurately indeed) 
depend on the degree of inflammation: but that the several re- 
medies for inflammation, however, do not relieve the pain and 



358 

itching which attend this complaint; and that it is important 
to know that what will cure one will do no good to another; 
therefore they must be varied. In some cases, great relief is 
obtained from washing the part with spirit, brandy, laudanum, 
and the like; and in others, poultices afford most relief. Leech- 
es are often useful when the inflammation is considerable: also 
cold water, or snow, applied to the part, and repeated and con- 
tinued till the pain abates. Strong fresh lime water has been 
recommended, to bath the part in, morning and evening, for 
half an hour. Spirit of hartshorn, oil of turpentine basom 
copaiva, asilicum ointment, tar ointment, and ointment of 
Jamestown weed, have occasionally afforded relief. I have suc- 
cessfully used a plaster made of powdered opium and soap: 
also of laudanum and sweet oil; and I think with greatest effi- 
cacy, a plaster made of one drachm of powdered opium and half 
a drachm of sugar of lead, rubbed up with a little hogs' lard 
and thinly spread on the part. 

When sores arise from chilblains, they are to be treated as 
sores from other causes. 



FRACTURES. 

The breaking of the bones of the body, may be the result of 
external violence, or of the sudden action of the muscles, or 
the conjoint operation of both. The bones most frequently 
broken, are those of the extremities. It is called a simple 
fracture, when there is no opening from the fracture exter- 
nally; but a comfiound fracture, when there is an external com- 
munication. The causes of fracture, are as endless, as the va- 
riety of accidental force to which bones are exposed. In old 
age, as well as in particular diseases of the constitution, bones 
are more liable to be broken: and also, in winter. This was 
supposed to arise from the influence of cold; but Dr. Physic 
gives a better explanation; he considers it as the result of ex- 
traordinary muscular action, excited by the exertions to avoid 
falling on the frozen and slippery places or pavements. Hence, 
persons whose muscles are relaxed, as in a state of intoxication, 



350 

much less frequently have their bones broken from a fall, than 
those who are sober and very solicitous to guard against tum- 
bling. 

The symptoms of fractures are, severe sudden pain, altera- 
tion in the form of the part, sometimes a shortening of the 
limb, an inability to move the limb without severe pain at the 
injured part, an inequality of the skin covering the bone: a 
grating, called cre/iitation, of the edges of the bone against each 
other; a motion and noise not to be mistaken for any other. — 
By taking hold of the limb above and below the fracture, and 
moving the fractured extremities of the bone, the noise is pro- 
duced, and the existence of the fracture rendered unquestiona- 
ble. It is well here to remark, that the fewer these attempts 
are made, the better; as it is injurious that the edges of the 
bone should be much rubbed over each other. When the parts 
are much swelled before examination, the difficulty of ascer- 
taining the fracture is increased. 

The reunion of fractured bones is effected nearly in the same 
manner as that of the soft parts. The inflamed vessels pour 
out the matter necessary for the union, and the absorbing ves- 
sels take up the unnecessary parts. The matter poured out for 
the union, is called callus; it is at first soft, but gradually be- 
comes firmer, and completely ossifies. 



TREATMENT OF FRACTURES. 

The indications in the treatment of fractures are, to place 
the parts of the broken bone as near as possible in their origi- 
nal position, and to keep them so until union is effected. The 
first is done by moderately extending the parts, so that the 
edges may be made to come in contact; the other is done by 
the application of splints and bandages. 

The treatment of the patient, as it relates to the constitution, 
is to be regulated by circumstances. A certain degree of in- 
flammation is essentially necessary for the process of restora- 
tion. If it be too violent, instead of the formation of callus 
for the reunion, common matter will be formed: it will come 



360 

out, and, thereby making an opening, will convert a simple 
into a dangerous compound fracture. Hence the inflammation 
must be regulated, not so much by purges, as generally it is 
very inconvenient; but chiefly by blood-letting and low diet. 

When the soft parts are much injured, greater attention is 
necessary to keep down the high action, than when only the 
bone is broken. In cases where there is much swelling, or 
much effusion of blood, cold applications of lead water, and 
free bleeding, can alone prevent the formation of matter. In 
every case where it is proper for the patient to remain in bed, 
it is necessary to have a bed pan for the evacuation of his bow- 
els; if a good one cannot be got, you will have to use the sub- 
stitute I have recommended to the attendants on the sick. But 
a better mode will be to have the patient laying on a mattress, 
with a hole in it of proper size; the mattress should be on a 
plank bottom, as a door, in which another hole is to be, corres- 
pondent to that in the mattress; in these holes, are to be suita- 
ble stoppers. And when the patient wishes to evacuate, the 
door and all are to be elevated, the stoppers removed, and a 
pot placed underneath to receive the discharge, which being 
finished, the whole is to be replaced. In some places, bedsteads 
with screws and pullies, are made to effect these objects: but 
as they cannot be had in the country, a contrivance can be 
made to answer in the way I have suggested, requiring no skill 
in construction, and the labour of only one or two to place and 
replace it. Under any circumstances, it is improper to place 
the patient on a feather bed, on account of the irregularities 
necessarily ensuing. If a hair or wool mattress cannot be pro- 
cured, it is better to substitute a few folded blankets on even 
boards. All fractures should be examined in the course of six 
or eight days after they have been reduced, to rectify any dis- 
placement. 



861 



PARTICULAR FRACTURES, OF THE MOST COM- 
MON KIND. 

FRACTURE OF THE LOWER JAW. 

This bone is liable to fracture in all its parts. The symp- 
toms are, severe pain at the time of the accident; an inequali- 
ty is perceived in passing the fingers along the bottom of the 
jaw; the teeth, on examination, are found unequal; and on tak- 
ing the two sides in the hands, it is easy to reduce the teeth 
to their proper level, and in doing so, the grating motion is 
perceived. 

To reduce the fracture, nothing more is necessary than to 
shut the mouth, and forcibly push upwards the lower fragment, 
until the teeth contained in it come in contact with those of 
the upper jaw, when it is to be supposed the parts are in pro- 
per place. The simplest and best plan to keep the parts in 
place, is to avail yourself of the support given by the teeth in 
the upper jaw, by binding the fragments firmly against them, 
and this can be very conveniently done by means of a simple 
roller of common cotton muslin passed repeatedly round the 
top of the head and under the chin. It may be further secured 
by passing a few turns of it round the back of the neck and in 
front of the chin. 

The patient should be nourished fifteen or twenty days on 
spoon victuals, sucked between the teeth; and the only addi- 
tional remark I have to make, is that when the teeth at the frac- 
tured boirc are loose, they are not to be touched; much less re- 
moved,*as that would convert the simple into a compound frac- 
ture, or, in other words, admit the air to the broken parts of the 
bone. 



V v 



362 



FRACTURE OF THE RIBS. 

These are generally broken near the middle. The fracture 
is ascertained by a severe pain in breathing: by careful exami- 
nation with the hand: and by feeling the grating of the bones, 
particularly when the patient coughs. The only treatment ne- 
cessary, is to pass a roller about six inches wide repeatedly 
around the chest, and as tight as the patient can suffer it to be 
drawn. It is to be prevented from falling down by shoulder 
straps. 

When the edges of the bone have wounded the lungs, there 
is spitting of blood: and violent, if not. fatal, inflammation will 
follow, unless the patient be freely evacuated with the lancet 
and by purges, and made to live on a very spare diet. 



FRACTURE OF THE ARM. 

This most generally occurs about half way between the 
shoulder and elbow. When it is broken directly across, and 
near the middle of the bone, no great derangement takes place; 
the limb preserves its length, and its form too, unless it be 
moved. The mode of treating this fracture, is to set the pa- 
tient on a chair; one person is to hold the body, with his arm 
around the chest; another the forearm bent at right angles over 
the breast, and to raise it a little from the side, and extend it 
when the operator is to place the two ends of the bone in con- 
tact; to pass around the arm, from the elbow to the shoulder, 
a roller, moderately to compress the part without impeding the 
circulation. He then applies a splint of wood, firm paste 
board, or of raw hide, on the top of the arm, from the elbow to 
the shoulder; then another on the outside, of similar length: and 
in the inner side of the arm another, from the armpit to the 
lower part of the elbow. These are to be secured by another 
roller or bandage. Folds of flannel are to be placed in the arm- 
pit, to give some support, and the forearm is to be suspended 



363 

in a sling. At the expiration of a week, the parts are to be ex- 
amined, and, if found out of place, to be rectified; the joint at 
the elbow should be gently and carefully moved, in order to 
prevent stiffness: and this ought to be repeated, after the first 
week, once every other day. At the end of three weeks, it is 
recommended to alter the dressing and substitute splints, which 
instead of keeping the arm bent at right angles, will keep it 
nearly extended. This is done to prevent its partial deformity. 
Dr. Physick states that the same effect will be produced by 
keeping the patient in bed, with the arm bent at the elbow and 
lying on its outside, supported by a pillow. 



FRACTURES OF THE FOREARM. 

The forearm is composed of two bones; and sometimes only 
one of them is broken, at others both. The symptoms are great 
pain at the time of the accident, increased by motion of the 
hand; an inability to turn the hand either up or down, and the 
grating common to all moveable fractures. 

To reduce the fracture, the forearm is bent to a right angle 
with the arm; an assistant takes a firm hold of the arm just 
above the elbow; a roller is to be applied, extending from the 
hand to a little above the elbow; two splints, broader than the 
arm, made of either of the materials before mentioned, are to 
be applied, one on the inner and the other on the outer side of 
the hand, extending from the fingers up to the elbow, leaving 
the thumb upwards, projecting between them. The hollow 
places should be filled up with tow or cotton, and a bandage 
applied around, to preserve the whole in place. 

In about ten days the parts are to be examined, and rectified 
if de'ran ged. In thirty or forty days, the union is generally 
completed. The elbow and wrist should be moved every other 
day, as in fractures of the arm, after the first week. When 
only one of the bones is broke, the treatment should be the 
same. 

When the bone at the elbow (called olecranon) is fractured, 
it is drawn up by the muscles attached to it, leaving a consid- 



36* 

erable space between the broken parts. The proper treatment 
of this accident is to extend the arm, and apply a broad ban- 
dage around the arm to compress the muscles, and thereby 
prevent their action in separating the broken part. The sepa- 
rated bone is to be pushed down to its natural place, and a 
long compress placed on it, over which is to be applied a roll- 
er extending the greater way over the arm and forearm : a 
large long splint is to be put on, extending from the inner part 
of the arm to the hand, and a roller is to be applied from be- 
ginning to end. It should be so passed around the elbow as 
to form a kind of figure of 8, in order that the upper- part of 
the bone may be drawn down by its oblique compression. In 
about thirty days, the joint may be very gently moved by the 
hand of an assistant~but it is not to be attempted by the pa- 
tient for near double that time, as the parts otherwise might 
be ruptured again. -• 

}n fractures of the bones of the hand and fingers, all that is 
requisite, is to restore the parts as accurately as practicable to 
their natural position, and preserve them in as quiet a state as 
possible; taking care, as in all other cases, to prevent the inflam- 
mation from extending too far, 



FRACTURES OF THE THIGH. 

The directions for treating these fractures in the systems of 
surgery, are t6o complicated for me to be able to give them 
without the aid of plates to explain. There can be no doubt, 
but that in all such cases when surgical aid can, it will be ob- 
tained. But in case of this being impossible, it may be of ser- 
vice for me to add, that the patient is to be laid on a mattress 
on boards, with a hole in it for the evacuation of his bowels.— r 
That instead of the splints recommended by Desault and 
others, on such occasions v it may suffice to have a box made 
without a top, just wide enough to receive the limb, and of 
length to extend six or nine inches beyond the foot, up to or near 
the privates, with the outer plank, or side of the box, to ex- 
tend by itself up to or near the armpit. In this part there is 



365 

to be a couple of holes, for tieing a bandage securely. The 
limb is to be placed in the box, with a pocket handkerchief so 
equally applied to the foot, that it shall not bind too much on 
any one part. Another poltet handkerchief is to be applied 
between the thighs; one end to go under the buttock, up to the 
hole in the outside plank of the box; the other end is to go up 
in front to the other hole, and the two ends are to be tied toge- 
ther. The next operation, is to ; pu-ll the limb downwards, and 
put the bones in place: and the handkerchief around the foot is 
to be extended and secured to the -end of the box by any con- 
trivance that will hold it. Thus the handkerchief between the 
thighs will preserve the extension above, and that at the foot 
will extend the lower limb, and it may occasionally be drawn 
tighter. 

This rude sketch, I hope, will enable you to do some good 
on such occasions. I have to add, that the box ought not only 
to be made of firm materials, but should be well lined or stuffed 
in every part where it touches the flesh of the patient, with 
finely carded and smoothly placed cotton or tow, to prevent 
excoriations. 



FRACTURES OF THE KNEE PAN. 

These are very analogous to fractures of the end of the el- 
bow, occasioned by falls, blows, and other violence, as well as 
too great action of the muscles. When this accident occurs, 
the patient generally falls; though sometimes he gets up and by 
dragging the limb sideways, may be able to walk, taking great 
care not to bend the knee. A depression or hollow at the place 
of fracture is perceived, and commonly the upper is found con- 
siderably drawn up from the inferior part, which is fastened to 
the lower bone. 

The great object to be attended to in the treatment of these 
fractures, is to preserve the fragments as near as possible toge- 
ther, so that the substance connecting them, may be as short as 
possible, and the motions of the joint be perfectly preserved. — 



366 

In proportion to the violence producing the fracture, should be 
the attention to keep down inflammation. 

The local treatment consists in keeping the limb at rest, in 
an extended posture: and by a splint and bandages preserving 
the contact of the fragments. This is done by taking a piece 
of plank about half an inch thick and three inches wide, and 
extending from the buttock to the heel. Upon this splint, co- 
vered with folds of cotton or flannel so as to fill up the inequa- 
lities of the limb, the patient's leg and thigh are to be placed. 
A common roller is to be carefully applied from the foot to the 
thigh, so as to equally compress all parts, leaving none expos- 
ed; but you are to observe, in passing the rooler over the knee, 
as in the case of the elbow, it is to be so done as to press down 
the upper to the lower part; making, as in the other case, the 
figure 8; so that the roller as frequently passes one part below, 
the other above the fragment several times, when it is to be 
continued to the thigh. A compress of folds of flannel, should 
previously be put over the knee. 

The limb is then to be equally bandaged to the splint under- 
neath. Dr. Dorsey recommends too slips or bands of doubled 
muslin, each a yard long, to be nailed underneath, the splint, at 
a distance of six inches from each other, and about the middle 
of the splint, or just so as to be underneath the knee. These 
bands are to be passed — the lower one above the upper frag- 
ment, and the upper one below,— so as still to make the figure 
8, and press down the upper to the lower part. The joint 
should gently be moved by an assistant about the thirtieth day, 
to be continued moderately every other day, to prevent stiffness. 



FRACTURES OF THE LEG. 

These are distinguished, as in other cases, by pain or dura- 
tion; deformity of part; and the grating peculiar to broken 
bones. 

In fractures where the bone is broke directly across, it is 
merely necessary to reduce the fracture with the hand, when 
the limb is extended, and apply a roller from the foot to the 



367 

knee; then two splints, one to each side, of pasteboard or thin 
plank, extending from the knee to the sole of the foot; and over 
these splints another roller is to be applied, to preserve them 
in their places. The bandages should never be drawn too 
tight, as the limb will swell, and they may do injury by com- 
pression. The limb is now to be placed on a pillow, and put 
in a box, or, what will answer, between two long slips of plank, 
which are to be tied around, so as to support the whole. 

When the fracture, instead of being directly across, is in an 
oblique direction, it is necessary to dress the limb in the same 
way as in fractures of the thigh bone; excepting that, when the 
fracture is hot near the knee, the upper part of the box may 
be fastened a little below or around the knee; and therefore its 
external side need extend no farther. There should be a hole 
in the upper part of both the inner and outer side of the box, 
and the handkerchief or band should be so made as to pass 
from the knee through each of these holes, where it is to 
be fastened. Another handkerchief is then to be applied 
around the foot, which is to be extended; then the ends of the 
handkerchief fastened to the end of the box, so as to preserve 
the extension of the limb. Of course, a roller is first applied 
around the leg from the foot to the knee; and the box is to be 
well supplied with cotton or tow, to fill up the inequalities of 
the limb. 



FRACTURE OF THE COLLAR BONE. 

The name of this bone is clavicle; and it is probably as of- 
ten fractured as any other of the body. It is commonly broken 
about its middle. When it is broke, the part nearest the 
shoulder is drawn downwards by the weight of the arm; the 
arm of the affected side falls over upon the breast, and the pa- 
tient is unable to raise his hand upon his head. He leans to 
the fractured side; the grating of the bones may be perceived; 
and the finger passing over the bone, will readily detect the 
place of fracture. 



368 

This fracture has frequently been successfully treated, by 
simply keeping the patient laying down, with his arm so plac- 
ed, that the broken edges of the bone may be in contact. But 
most commonly it is dressed in the following manner: A 
bolster or pad is to be made of quilted cloths, in the shape of 
a wedge, about as long as the arm; four inches wide, and at 
least three inches thick. This is to be put under the arm, 
the base close to the armpit, the point down the side; and it 
is here to be well secured by a roller passing around the body, 
and so turned over the shoulder, that it cannot be displaced: 
a contrivance which any one can make, who will exercise com- 
mon sense. The patient being seated on a stool, and held by 
an assistant, the operator is to bend the elbow at right angles, 
and the forearm is to be supported by a sling around the neck; 
the arm and elbow are to be pressed to the side; the wedge 
above acts as a point for the extension of the broken bone, and 
it is to be bound down in that state by a wide roller passing 
around the body and over the elbow. It is impossible to give 
an accurate description of the particular manner of applying 
the bandages. By the exertion of sound sense, it can be done 
to effect the main objects, which are, first, to preserve in place 
the wedge underneath the arm; second, support the arm bent 
on the breast; and third, to press down and keep the elbow on 
the side, so that it shall cause the extension of the upper part 
of the arm, and consequently the broken bone. A slip of ad- 
hesive piaster will be sufficient to cover the broken bone. 



DISLOCATIONS. 

This is a displacement of a bone at its joint from its natural 
situation. Some knowledge of anatomy is indispensably neces- 
sary to understand accurately the subject of each particular 
dislocation. In general, it may be remarked, that parts are lia- 
ble to this accident in proportion to the freedom of their mo- 
tion. Hence the shoulder joint is most subject to displace- 
ment. The action. of the muscles of parts, certainly assists in 
producing dislocations, as it does in fractures.. . 



369 

The symptoms which distinguish dislocations are, pain and 
inability to move the member; a change in the appearance of 
the joint; a lengthening or shortening of the limb, and an im- 
possibility of performing particular motions. By careful ex- 
amination, the displaced bones may often be felt in their new 
situations, producing elevation in some parts, and depression 
in others. 

The principal obstacle to the replacement of bones, is the 
contraction or strong action of the muscles, drawing the dislo- 
cated part from its natural position. In order to overcome 
this action, it is customary to bleed the patient until fainting 
is produced, or to give a dose of tartar emetic to relax the 
system; and it may also be done by an injection of tobacco.— * 
In the relaxed state following such treatment, the reduction is 
often easily effected. Assistants' hands are all that is requisite 
in common cases of dislocation. In cases where pullies are 
requisite, surgeons only should attempt to operate. And you 
should always apply for assistance as early as possible; for the 
longer the part remains out of joint, the more difficult will be 
the reduction. 

In cases of dislocation where inflammation comes on, the use 
of leeches or cupping should be resorted to; bleeding, purging, 
and low diet, of course, to lessen the feverish symptoms. Rest 
should be strictly enjoined; and the parts may be bathed in 
lead water, in a solution of crude sal ammoniac, in vinegar and 
water; or cloths from hot water may be applied, to foment the 
part, or allay irritation. 



DISLOCATION OF THE LOWER JAW. 

This accident, in most cases, is produced by yawning, or 
opening the mouth excessively wide. It is sometimes produc- 
ed by a blow upon the chin while the mouth is opened. The 
symptoms of its occurrence are, an inability to close the mouth-, 
immediately before the ears an empty hollow space is perceived : 
the cheeks and temples are flattened; the spittle flows from the 
mouth; speech and swallowing are difficult, and the cjiin pro^ 
W w 



370 

jects forwards. When the jaw continues dislocated several 
days, these symptoms are not so strongly marked, though they 
are still in greater or lesser degree. 

To effect the reduction, the patient is to be seated on a low 
chair; his head supported against the head of an assistant; the 
operator is to defend his thumbs with a piece of leather or 
linen: he is then to place them as far back on the jaw teeth as 
he can; the fingers are then placed under the chin: and while 
he presses down the back teeth with his thumbs, he at the same 
time raises up the chin with his fingers; and then the chin is 
pushed backwards, when the parts become replaced very sud- 
denly. As this is done, the operator is as quickly to move his 
fingers from under the teeth to the cheek. After the opera- 
tion, the patient should for some days live on spoon victuals, in 
order that the jaw may be at rest to recover its strength. 



DISLOCATION OF THE COLLAR BONE. 

This accident is generally occasioned by falling on the shoul- 
der, and is ascertained by examining with the fingers; the end 
of the bone being found under the skin covering the elevated 
point of the shoulder bone, there causing considerable projec- 
tion. The patient inclines his head to the affected side, and 
moves the arm and shoulder as little as possible. The treat- 
ment of this accident is precisely the same with that of frac- 
tures. 



DISLOCATION OF THE SHOULDER JODXT. 

These are so frequent, that it is said they exceed in numbers 
all the other dislocations which occur in the body. The most 
common dislocation of this joint, is when the head of the bone 
is removed downwards. The symptoms of its occurrence are, 
a depression over the joint, while the other is found round; the 
arm is larger than the sound one; its direction is changed; it 
stands off from the body, and the patient cannot draw the 



371 

elbow close to the side; and the round head of the bone is felt 
under the armpit. 

To reduce the bone, the patient is to be seated, and the ope- 
rator is with one hand to press firmly against the projecting or 
upper part of the shoulder blade, and with his other grasping 
the arm above the elbow, he is forcibly to extend it: and very 
frequently the reduction takes place instantly. In other instan- 
ces, it has been done by an assistant's holding back the same 
point or process of the shoulder bone; sometimes one or two 
others press their hands on that of the first, to aid in making 
the resistance; and the operator, with the arm bent, extends it, 
and reduces it. Sometimes it is necessary to make the resist- 
ance by means of a girth or band, passed over the same pro- 
jecting part, and fastened to the wall; and then a napkin is to 
be folded around the elbow and upper part of the forearm, by 
which extension is to be made by assistants; when the operat- 
or, by a little moving the arm, and pushing up with one hand 
the head of the bone, will generally succeed in making the re- 
duction. 



DISLOCATIONS OF THE FOREARM. 

The forearm is not frequently dislocated; and when it is, it 
is generally backwards and laterally; and arises from a fall on 
the hand, when extended to protect the body. In this state, 
the forearm is half bent; and attempts to extend it, occasion 
great pain. 

The reduction is effected by seating the patient in a chair, 
when one assistant is to grasp the wrist, and the other the arm 
near the shoulder, each moderately extending or pulling: the 
operator is then, with his fingers around in front of the arm, 
just above the elbow, to draw it backwards, and endeavour also 
to push the projecting part of the elbow downwards, and con- 
sequently into its socket. But really these operations can only 
he properly understood and performed by those acquainted with 
the construction of the parts, and hence should be referred 
only to surgeons, with those of all the other parts of the body. 



372 

No directions can be given but those of a very general nature: 
When the parts are very painful or swelled, bleeding is requi- 
site, as well as cold applications; and on making very mode- 
rate extension, slowly and long continued, the parts are to be 
pushed into their natural situation, as well as they can. 



SMALLPOX. 

This is a contagious disease, marked by a fever which is at 
first inflammatory, but now and then becomes of the low or 
nervous kind, accompanied with vomiting and occasional pain 
in the stomach. In a few days the fever ends with an eruption 
of red pimples, generally on all parts of the body. In these, in 
a short time after, matter is formed; and then they dry up, and 
leave frequently small pits, and sometimes scars in the skin. 

The smallpox attacks people of all ages; but the young of 
both sexes are more liable to it than those who are much ad- 
vanced in life: and it may prevail at all seasons of the year; but 
in general is most prevalent in the spring and summer. It ve- 
ry seldom happens that a person is attacked a second time with 
the disease, however afterwards exposed to its infection. The 
disease is divided into two kinds — the distinct and confluent. 
In the distinct, the eruptions are quite separate from each other; 
but in the confluent kind, they run much into one another. — 
The distinct may be distinguished from the confluent, before 
the eruption appears, by the mildness of its attack, by the in- 
flammatory state of the fever, and by the late appearance of the 
eruption. Occasionally irregularities in this disease are to be 
met with in practice: sometimes in the pocks, the fluid never 
becomes opaque, or like common matter; small blisters appear 
between the pocks; — but they are only different modifications 
of the same disease. 

The distinct and confluent smallpox are produced by breath- 
ing air impregnated with the eiRuvia arising from the bodies 
of those who labour under the disease; or by the introduction of 
a small quantity of the matter into the system, by inoculation: 
and it is probable that the variety of the smallpox is not owing 



373 

to any difference in the contagion; but depends on the state of 
the person to whom it is applied, or on certain circumstances 
concurring with its application. 

A few days before the disease appears, the patient feels great 
languor and weariness; then follow cold shiverings and tran- 
sient glows of heat, succeeded by fever, with violent pain of the 
head and loins, and often a severe and oppressive pain at the 
pit of the stomach. The person is drowsy, and sometimes de- 
lirious. Small eruptions, similar to flea bites, appear on the 
face, neck, and breast, about the third day. The pimples now 
gradually increase, and on the fifth or sixth day begin to turn 
white at the tops. 

In young children, startings and convulsions are apt to take 
place a short time previous to the appearance of the eruption, 
and give great alarm to those not knowing the frequency of 
their occurrence. 

This disease is to be treated, by avoiding every thing of a 
heating, inflammatory nature: and by keeping the subject of it 
in a cool, quiescent state. The diet should be of the vegetable 
and mildest kind; and the drinks, of a similar kind, made agree- 
able by the addition of the most palatable acids. The bowels 
are to be kept open by any of the purgative salts; and, above 
all, the patient is to have cool and pure air— never oppressed 
by clothing, or a heated room. The temperature of the cham- 
ber should always be such that he may experience no disagree- 
able degree of heat; but rather a sensation of cold: and, except 
he complains of being chilly, no fear need be entertained of car- 
rying the cooling regimen too far. His bed should be a mat- 
tress covered only with a few bed clothes. 

In the early stage of the smallpox, and during the eruptive 
fever, when the symptoms run high, in addition to exposing the 
patient freely to cool air, it has been recommended to wash the 
body partially or generally with cold water. This practice 
has sometimes lessened the headach, pain in the back, and 
other feverish symptoms; a moderate, gentle perspiration suc- 
ceeds, and a mild eruption takes place. Where it is resorted 
to after the pocks have made their appearance, and by their 
quantity and the duration of the fever, a confluent pock is ex- 



374' 

pected, the cold bath tends not only to moderate the feverish 
symptoms, but dimmish the number of the pustules; and in do- 
ing so, greatly lessen the danger of the disease. 

In most instances, little more will be requisite than to pur- 
sue the course suggested; but sometimes the fever and gene- 
ral inflammation run so high, (particularly in grown persons 
of a full and robust habit,) as to be accompanied with great heat 
and dryness of the skin, redness of the face and eyes, consider- 
able difficulty of breathing, acute pain in the head; and stupor, 
01" delirium, comes on. In such cases, it will be necessary to 
bleed; but in resorting to this operation, great prudence is ne- 
cessary: for, should a fever of a malignant or nervous nature, 
follow the attack, bleeding might prove injurious. In general, 
local blood-letting by scarifying and cupping the temples, or 
the application of leeches, ought to be preferred. Where the 
eyes look red and fiery, or stupefaction prevails, bleeding near 
the part may prove a valuable remedy. The same caution 
should be observed with respect to the use of purgatives, for 
the purpose of diminishing excitement, in the distinct small- 
pox. They may prove serviceable if administered in modera- 
tion; but if the accompanying fever is of the nervous or low 
kind, then free evacuations of all sorts are improper. To emp- 
ty the bowels in such cases, where costiveness prevails, we 
should only employ the most gentle laxatives, with the occa- 
sional use of clysters. 

In cases of continued high fever, it will be proper to give 
small doses of antimonial medicines, as recommended for com- 
mon fevers; and whenever there appears any local affection, we 
should endeavour to remove it by local remedies. After the 
subsidence of the first fever, the system remains in an inflam- 
matory state, and a second fever is apt to ensue. The treat- 
ment of this is similar to that of all other fevers, whether of 
high or of low action. 



875 



COW POCK. 

The cow pock consists of a single vesicle, which appears 
where the matter is inserted. The colour is dull white; but it 
is red at its edges. It contains a fluid as clear as crystal, about 
the eighth or ninth day. A redness or inflammation of the 
skin spreads to a little distance from it^ about the size of half 
a crown. This begins to fade on the eleventh or twelfth day, 
and the vesicle becomes brown, and presently is covered with 
a glossy, hard scab, which discovers, when it falls off, a perma- 
nent scar. Now we have here, first to consider where the ino- 
culation should be performed; and secondly, if it be complete 
in its effect. 

In boys, it is of little consequence where the vesicle is seat- 
ed, and the arm is as good as any part; but in girls it is better 
to inoculate on the outside of the thigh, a little above the knee. 
Upon the second point, there has been a difference of opinion. 
Parents cannot too generally know that the arm may inflame, 
and yet the vesicle may not be of the genuine kind. If the pro^ 
gress be different from the usual course, then there is always a 
doubt, lest it may not give security against the smallpox. If, 
for example, there be no red circle, or if, on the other hand, it 
appear early, for instance on the fifth or sixth day, and especi- 
ally, if the vesicle be not round or oval, but jagged or irregu- 
lar, and contain, on or before the eighth day, a turbid or white, 
instead of a clear fluid, it will be necessary to re-inoculate. It 
is possible also, that the vesicle may be of the genuine kind, 
but the constitution may not be fully affected by it. This can- 
not be determined by appearances or symptoms, but it may be 
by a very innocent and slight test. If on the morning of the 
sixth day, a second inoculation be performed on the other arm 
or leg, it will advance quickly, and become surrounded with a 
red circle, nearly as soon as the first vesicle will be. If this 
trial be neglected, we still have two other methods of deter- 
mining, if the constitution be properly altered. The first is, 
by inoculating with vaccine matter a any time after the child 



376 

has recovered completely from the first inoculation; the second 
is by using- smallpox matter. In either case, the scratch only 
inflames a little; it soon heals, and no other effect is produced. 
Without one or other of these tests, no child can be pronounc- 
ed secure; for I have seen smallpox succeed cow pock, where 
the vesicle had all the genuine characters, and had run its 
course regularly. In such cases, the smallpox has been mild, 
though the pustules have been copious, and contained as much 
matter as usual. If it be asked, why every parent does not re- 
inoculate as a test, I can only answer, that it is from the same 
cause which makes many neglect insuring their property; 
namely, a belief that there is no great chance of its taking fire. 
It has been urged as an objection against the cow pock, that 
it produced cutaneous disease afterwards, but this is ground- 
less. Smallpox, on the other hand, may be succeeded by the 
most troublesome boils, and may irreparably affect important 
organs, or the whole constitution. 

With regard to the treatment of cow pock, I have nothing to 
observe, except that the part should, when the circle forms, be 
dusted frequently with flour or chalk; and after the vesicle 
breaks, the same should be continued, in order to form a crust 
upon the sore, which is much better than dressing it with 
ointment. 



CHICKENPOX. 

The chickenpox is preceded by feverish symptoms, such as 
chilness, quick pulse, hot skin, restlessness, diminished appe- 
tite, thirst, and headach. In some cases, the fever is severe, 
and attended with distressing retching, great agitation during 
sleep, and even delirium. In others, it is scarcely perceptible. 
On the third day, the eruption appears, first on the body, and 
then on the face, and lastly on the extremities; when the erup- 
tion appears, the fever declines. The pustules, which are very 
itchy, early contain a yellow matter, or liquor, and by the fifth 
day are covered with scabs, which leave no pits. There are 
different varieties of this disease, for in some the pustules are 



377 

iarger than in others, or go off sooner. This is scarcely ever 
dangerous, and is seldom even troublesome; nor is it generally 
necessary to confine the patient, or do more than give one or 
-two doses of gentle physic. The fever and uneasy feelings 
may be greatly mitigated, and the eruption rendered slighter, 
by washing the surface with cold water in the commencement 
of the disease. The itching may be abated afterwards, by 
sponging the skin occasionally with cold vinegar and water. 
In some cases, especially if the bowels be neglected, and the 
child be allowed to feed grossly, the fever may be strong, and 
the pustules become much inflamed. Some of them may even 
end in sloughs, which leave deep marks, worse than those of 
the smallpox, and as in that disease, so also in this, very trou- 
blesome boils may harrass the patient for a long time. This is 
chiefly the case in bad constitutions. I have mentioned the 
causes and the cure; the means of prevention, evidently consists 
in the use of laxatives and light diet. 



Xx 



ADDRESS VI. 



Of the remaining Diseases of the Body. 



INFLAMMATION. 

In all cases of inflammation there is an increased action of 
the blood-vessels, propelling the blood more rapidly and in 
greater quantity than usual, through the part affected; by which 
means*there is an increase of sensibility and irritability — with 
an enlargement of the part, attended with a throbbing, some- 
times extremely painful. 

When the inflammation is confined to one part, without 
affecting the general system, — as in boils, abscesses, and slight 
wounds; it is called local or topical. But when it produces 
effects on the whole system, it is known by the name, general 
inflammation; or inflammatory fever. 

There are two kinds of inflammation, very distinctly mark- 
ed and differently named. The first is called erysipelas, or 
St. Anthony's fire: the other, phlegmon, by which you are to 
understand that of a common boil — where the affection is con- 
fined to the skin and the cellular membrane underneath, with 
a swelling or prominence in the centre of a bright red colour, 
attended with heat, pain, distension, and a throbbing. Persons 
in full health and vigour, are most subject to these inflamma- 
tions; whereas those of weak, relaxed habits are most apt to be 
attacked with St. Anthony's fire, called erysipelas. 

Inflammations terminate in various ways. 
1st. By a gradual subsidence, called resolution; when all the 
blood that had been effused, is taken up and carried off, 



380 

2d. By the formation of matter, called ftus; the process be* 
ing termed suppuration. 

3d. By the death of the part, called gangrene, or mortifi- 
cation. 

4th. By the effusion of blood, and its consolidation into a 
hard tumour, called schirrous. 

5th. By the secretion of a watery fluid — as from blisters, and 
in dropsy of the head and belly. 

The remote causes of inflammations of this sort, are various 
irritations of a mechanical or chemical nature; wounds, bruises, 
acrid substances, &c. Sometimes they are the consequence of 
fever; and in other instances the cause cannot be traced. 

When suppuration is about to commence, the symptoms of 
inflammation are greatly increased; the pain and throbbing be- 
come more violent; the heat is augmented; the swelling is more 
prominent; the colour more intense, approaching to a pale scar- 
let; shivering fits come on; the swelling grows softer, ai*l mat- 
ter is formed. Its fluctuations may be perceived by examining 
with the fingers. An abatement of the symptoms now takes 
place. The absorbent vessels then take up the part between 
the matter and surface, thereby making an opening for its 
escape. 



TREATMENT OF INFLAMMATION. 

Dr. Dorsey very judiciously classes the treatment under the 
heads of constitutional and local. Those which act on the con- 
stitution, are, 

1st. Blood-letting. This is a most powerful remedy. The 
quantity of blood to be drawn, and the frequency of its repeti- 
tion^ are to be regulated by the violence of the inflammatory 
symptoms. Whenever parts essential to life are inflamed — as 
the brains, lungs, and contents of the belly; copious bleedings 
become more necessary. 

2d. Low Diet. This not only diminishes the fulness of the 
vessels, but lessens the irritation, and is to be strictly en- 
joined. 



381 

3d. Purging is necessary, and should be had recourse to very 
freely, where it can be had without moving the patient when 
motion is improper, as in fractures. 

4th. Certain neutral salts, glauber and epsom salts, cream of 
tartar, and nitre, are useful in promoting the secretions: and 
when united to antimony, occasion sickness at stomach and les- 
sen the action of the blood-vessels. 

5th. Rest is essential; as motion occasions irritation, and ma- 
ny inflammatory affections are found difficult of cure, because 
the inflamed parts cannot be kept at rest — as, for example, af- 
fections about the fundament and joints. 

6th. Position. The posture of the body should be such as to 
favour the return of blood from the inflamed part. In many 
local inflammations, this is of extreme importance. The ele- 
vation of the feet in cases of inflammation on the lower extre- 
mities, is found highly useful, by emptying the blood-vessels of 
the affected part. 

7th. Opium may be given to relieve pain, in some cases. 

The local remedies are, 

1st. Bleeding from the inflamed part, by cupping, leeches, or 
scarification. Local blood-letting is most effectual after gene- 
ral bleeding. 

2d. Cold afi/ilications are sometimes of service; but are not to 
be carried so far as to be unpleasant to the patient's feelings. 
The most common application to reduce the heat of the inflam- 
ed part, is a solution of lead water, with or without vinegar — 
about one drachm to the pint of water. It is to be applied on 
linen rags, and they should be renewed as speedily as they be- 
come warm. 

3d. Blisters. These, in certain cases, are of great use in di- 
minishing inflammation. They are to be applied directly over 
the part, and in many instances they will produce a speedy 
oure. 

When it is desirable that suppuration should take place, and 
when it is inevitable; the best applications are those of a mild, 
soothing kind: as oiled poultices of bread and milk, or flax seed 
pounded, or of slippery elm bark. When suppuration has 



38S 

taken place, and a fluctuation of matter is perceived underneath; 
as a general rule, its discharge is to be expedited by making an 
artificial opening; more especially should this be done in whit- 
low, or whenever the confined matter is painful: in all affections 
near the large joints, and near the throat, endangering swallow- 
ing or breathing, or which occasion any aifection of the consti- 
tution. The abscess can commonly be readily opened with a 
spring lancet: but when this is dreaded, a small piece of caus- 
tic vegetable alkali, rubbed over the part eight or ten minutes, 
will destroy it, and give vent to the matter. Healthy matter is 
perfectly bland, free from all acrimony. It is heavier than wa- 
ter, and sinks in it without mixing with it. It does not readily 
putrify: but when mixed with blood, or other foreign matter, it 
ferments, becomes putrid, acquires an offensive smell, and is 
acrid and irritating. The best dressing for boils, or abscesses, 
after the evacuation of the matter, is a soft bread and milk or 
linseed poultice, made up with lead water. 



ERYSIPELATOUS INFLAMMATION, 

COMMONXY CALLED 

ST. ANTHONY'S FIRE. 

This has been considered as a disease of what is called the 
true $kin, or the part next to the scarf or upper skin. It is 
marked by peculiarities. It commences at a particular spot 
and rapidly extends itself sometimes over a large part of the 
body. 

The colour of the skin in this affection, is of a bright scarlet. 
There is not much swelling, and a marked line clearly shows 
its extent.. Pressure on the skin causes the disappearance of 
the colour, which speedily returns. The pain is of a burning 
kind, and attended with great itching. It is most dangerous 
when in the face, and the swelling is there greatest. In some 
cases it is attended with small blisters, which contain an acrid 
fluid: and when they burst, scales and sores are formed. 



888 

When the affection is limited, it generally gets well in eight 
or ten days; the outer skin being cast off in small flakes tike 
bran. The system in this disease, is sometimes much affected, 
with great debility, headach, sickness at stomach and vomit- 
ing, followed by violent fever and delirium. 

The remedies are the same in this inflammation as for that 
of the common kind; that is, bleeding-, purging, small doses of 
tartar emetic repeated every two or three hours, low diet, and 
mild and cooling drinks. As a local application, rye meal, or 
wheat flour, is pleasant and useful; all greasy applications are 
improper. Sometimes a wash of lead water proves of service. 
A most important remedy, which should never be neglected, is 
blisters. They are to be applied over the swelled or inflamed 
part, and may extend an inch on the sound edges. When mat- 
ter is formed, large openings are to be made for its discharge, 
with their sloughs, which resemble wet tow. 



OF SALIVATION AND ITS DISEASES. 

This is known to be a profuse discharge of spittle from the 
glands of the mouth and around the throat, generally arising 
from mercury; though sometimes from any other kind of stimu- 
lus, as opium or spirit, and not unfrequently from a decayed 
tooth. But it is that from mercury of which I have to write. 

In attempting to salivate, we have to determine whether it 
is to be done quickly or slowly, so that the effects of the mer- 
cury may pervade the whole system. If to be done quickly, 
and only excited in the mouth, one grain and a half of corro- 
sive sublimate, dissolved in near a wine glass of spirit, and 
swallowed after laying down; a profuse discharge will soon 
follow from the mouth: and this may be repeated as often as 
desired, once or twice every day. Rubbing calomel on the 
gums, will soon produce the same effect; as also, exposing the 
body, when enveloped in some covering, to the fumes of mer- 
cury, in the shape of hepar sulphuris, a few grains of which 
are put, for the purpose, on a hot iron, and breathed. 



384 

But when it is to be made to operate slowly, so as to per- 
vade the whole system, it may be done by giving one-tenth of 
a grain of corrosive sublimate, to be increased, or one grain of 
calomel, morning and night: or by rubbing mercurial ointment 
over the body; but it generally suffices to rub it on the interior 
of the thighs and arms. When it affects the bowels, a little 
opium or laudanum should be added to it. In order that the 
whole system should be affected, salivation should be prevent- 
ed coming on to any great degree, ,by keeping up and taking 
as much exercise as possible; but avoiding exposure to cold, 
cold drinks, and rubbing the gums or stimulating the mouth 
with any thing, in diet or drink; and when the breath becomes 
offensive, with a copperish taste in the mouth, the medicine 
should be postponed for a day or two, when it may be renewed. 
When salivation has come on, and is very profuse, it may 
be lessened by keeping the head constantly erect, and by wash- 
ing the mouth with a solution of sugar of lead, twenty grains 
to the pint of water; cloths wet with which, should be applied 
around the neck and throat, and be frequently renewed. There 
are other gargles which some prefer, made of alum and honey, 
of a decoction of oak bark, of white vitriol, of sage and honey, 
and indeed of many articles commonly used for cleansing the 
throat. I greatly prefer what I have first recommended, with 
the additional means of keeping the mouth clean with finely 
powdered charcoal, made of burnt bread, which should be re- 
newed every hour or two; and a small quantity of it is to be 
swallowed to purify the contents of the stomach and bowels, 
which partake of the filthy nature of the spittle and breath. — 
Decayed teeth should always be extracted. 

There are other effects of mercury produced on the system, 
of a more serious nature. Sometimes it prevents the healing 
of sores; and indeed produces effects very like those of the ve- 
nereal disease in the. bones of the body. The best remedy has 
been found in the nitric acid, called aqua fortis, taken in doses, 
throughout the day, of one drachm, in as much water as will 
make it pleasantly sour, with sugar to render it palatable. — 
Sulphur, a tea spoonful morning and night, has been of ser- 
vice: and also a decoction of sassafrass tea and mezereon root. 



385 

Barks and wine, with exercise in the open country air, will 
prove beneficial, as indeed most of the medicines classed un- 
der the head of tonics. 



VENEREAL DISEASE. 

There are two species of this affection: the one marked oy a 
local affection of the mucus glands of the urinating canal in men; 
in women, of the birth channel; called the clap or gonorrhaea: 
the other produces sores about the parts of generation and af- 
fects by degrees the whole system, and is called commonly th€ 
Pox — and here is the proper place of treating it, after what has 
been said of salivation; since mercury is its only antidote. 

The matter producing pox first shows itself on the part 
where it is applied — constituting a sore called chancre. The 
nature of this is to be much inflamed; to be very tender and 
painful; to be unequal at the bottom; to have prominent edges 
of an ash colour, and to show no disposition to heal, but to 
spread very much and. gradually to affect the whole system; ex- 
citing tumours, called buboes, in the groin, resembling a com- 
m jn boil: and from thence contaminating the whole body in the 
most shocking or offensive manner. 



OF CHANCRES. 

/■■-'* 

The period at which these make their appearance, after the 
application of the matter, is various: being from five to forty 
days. When they first appear, the best application is lunar 
caustic, which is to be applied all over them by wetting the en£ 
of the caustic and slightly touching the parts, which are then 
to be filled with dry lint. Or they may be washed with a solu- 
tion of corrosive sublimate; or sprinkled with red precipitate, 
or with calomel; or dressed with mercurial ointment. The 
parts are to be frequently washed with soap and water. When 
very painful, the patient may take a dose of opium, if the ap- 
plication of a poultice of milk and bread to the member, does 
not relieve. 
Yy 



■ 




386 



OF BUBOES. 



These generally come on in one groin, sometimes in both, 
and have at first the appearance of what is commonly called a 
wax and kernel, but speedily enlarge and form matter, which 
is discharged by an opening, as in a common boil. There is 
so much danger from these when opened, that it is very impor- 
tant to prevent it. To do this, the diet should be low, and the 
patient a little evacuated. A strong vomit has often caused the 
disappearance of the- tumour. A blister covering the whole, 
and extending two or three inches around it, is a most power- 
ful means of dispersing it. It is to be renewed whenever it 
heals up, until the cure is effected. I have seen lately these 
tumours dispersed by keeping on them continually, a large pad 
wet with the strongest common lye; and I would warmly re- 
commend the trial in every case. 

When a bubo bursts, the matter is very apt to penetrate the 
parts; forming extensive canals underneath, called sinuses, 
which can in general only be relieved by cutting them open v 
and dressing them from the bottom with lint and simple oint- 
ments. But being early impressed with the important improve- 
ments Dr. Physick has made in practice by the free use of blis- 
ters in diverting action from the interior: having in some cases 
to cut open the most extraordinary openings, extending most 
incredibly; and knowing that the parts secreted much which 
was prevented by their inflamed state, I determined to dress 
the sores with nothing but blistering ointment, which was 
extended two or three inches around their edges; and the suc- 
cess exceeded my expectation. In the public hospitals, where 
I met so frequently with the disease, I never afterwards had 
an occasion to cut open another sinus. The sores are to be 
washed clean, and then a little calomel sprinkled over them; or 
a weak solution of corrosive sublimate should be put on them, 
and then the blister plaster, in small slips, daily renewed: and 
to be discontinued gradually, as the parts underneath granulate 
or heal up. 



387 



TREATMENT OF THE CONSTITUTION. 

This is to be done by giving mercury: as no local remedies 
will free the system from the poison; and I refer you to the pre- 
ceding article on salivation for directions. The mercurial state 
or action in the body should* be kept up from three to five 
weeks: and it is best to stop with it occasionally, and take the 
nitric acid directed above; at least, great attention is necessary 
to prevent the constitution from being too much debilitated by 
mercury: though more to prevent or remove the venereal taint; 
for when it does exist in the system, the danger to life and the 
extent of the suffering of the victim, are beyond all description. 
You will find it infinitely better to take too much than too little 
mercury. 



CLAPP, OR GONORRHEA. 

As before stated, this is only a local disease of the mucus 
glands of the parts affected — the urethra in males, and the birth 
channel in women. The latter suffer less from its effects than 
the former, who sometimes from sympathy labour under very 
serious affections in other parts. Its time of appearance after 
sexual intercourse, is nearly that of the pox. 

The only treatment women require, is to live low; to take 
occasionally a dose of salts, or cream of tartar; to wash clean 
in cold water very frequently, and to inject up the birth chan- 
nel a solution of thirty grains of sugar of lead in a quart bottle 
of water; it may be changed for white vitriol: or half the quan- 
tity of each together, will often prove better. If the parts are 
much irritated or painful, it will be better to inject a mucilage 
of elm bark, or any of our orchard gums; flax or mellon seed, 
with half an ounce of laudanum in a pint of the liquid, if the 
first alone does not relieve. 

The disease in men> begins with an uneasy sensation about 
the parts of generation: such as an itching about the point; a 



388 

soreness and sort of tingling- along the urethra; soon after, there 
is an appearance of whitish matter at its orifice, and some de- 
gree of burning in making water. In the course of a few days, 
the matter will increase, become yellowish, or greenish, and 
thinner; the scalding will be greater, and the parts appear 
redder. 

In men, the disease requires great care and attention.— i- 
They should live low, drink mucilaginous liquids, take laxa- 
tives of salts or cream of tartar. Their injections should be 
the same as above, and may be varied to. half a drachm of calo- 
mel in eight ounces of mild mucilage. They should always 
make water before injecting it, and keep the matter up for 
some time before discharging it. The injections should be 
made from five to ten times a day. The parts should be kept 
very clean; and the hands always washed after the operation 
with the utmost care, as from neglect the matter has been ap- 
plied to the eyes, and always produced total blindness. 

The unpleasant effects of the clap, not treated properly, are, 

1. An inflamed state of the part, producing a continued erec- 
tion, called chordee, which occurs mostly when the patient is 
warm in bed. It may be relieved by applying rags wet with a 
watery solution of laudanum, and removing them on becoming 
cold. A dose of laudanum at night, of fifty or sixty drops, 
may be taken. Sweet oil may be injected, and also applied 
around the part, which may also be enveloped in a solution of 
sugar of lead. 

2. An inflamed state of the skin at the head of the member, 
is no uncommon occurrence. It is generally the result of un- 
cleanliness and too high living. The skin is enlarged and puf- 
fed up, and fixed either before or back of the head of the penis. 
This affection should be treated by covering the part with a 
warm mild poultice, or by keeping it wet with a cold solution 
of lead water. If the inflammation does not speedily subside, 
bleeding at the arm and free purging are to be had recourse to. 
The patient should generally lay down; or if walking, keep the 
member supported upwards on his belly by suitable bandages. 
It will be adviseable to inject a little warm milk and water be-., 
tween the skin and head of the penis to keep the parts clean. 



389 

If these affections are not early attended to, it will be necessary 
to cut open the skin, or circumcise the subject. 

3. The swelling 1 of the testicles is a frequent attendant on the 
clap — arising mostly from using injections too strong and not 
keeping the system low, by moderate diet and drink and evacu- 
ations. In these cases the system is to be freely evacuated, by 
the lancet and purges: leeches may be put on the testicles, 
which are to be suspended in a bag; and the parts are to be 
kept cool with rags dipped in lead water, renewed as they be- 
come warm. These remedies will surely subdue the swelling, 
if carried to a proper extent. A strong vomit will be found 
an auxiliary, and the evacuation of the seed in the testicles is 
recommended as proper — but not with women. 

4. Warts about the parts now an then appear after this dis- 
ease: they are to be removed by the knife or tieing a th, I 
around them, and rubbing with mercurial ointment. 

5. The disease called the gleet not unfrequently follows the 
clap. It is a discharge of mucus from the urethra similar to 
the discharge called whites in women. It is to be treated in 
the same way — by moderately astringent -and stimulating in- 
jections. These may be made of a decoction of oak bark; of 
weak port wine or brandy and w^ater; of the balsam copaiva, 
and articles of similar nature. A blister kept up running near 
the member, below the bag holding the testicles, has been re- 
commended. I would not hesitate to apply a blister half an 
inch w T ide and as long as the urethra can be felt over the whole 
of it. The constitution is to be attended to in this affection. It 
is said on good authority, that thirty drops of the tinctuie of 
the muriate of iron given three times a day, has proved of g:eat 
service in gleets. Tonics to give strength should be given to 
the weak. But the best internal medicine in most cases, is the 
tincture of Spanish flies in water, twenty-five drops thrice a 
day. The uva ursi plant is also recommended. 

There are two other modes recommended for curing the 
clapp. The first is, to give twice or thrice a day about thirty 
drops of the purest balsam of copaiva. The second is to ex- 
cite the salivation as before described — by taking one grain 



390 

and a half of corrosive sublimate in a wine glass of spirit every 
other night for four or five nights, and taking a dose of salts 
the following day. 

Prevention. — There is very little doubt but that this disease 
could be prevented from propagation by men, if at sexual inter- 
course with polluted subjects, they would sprinkle and rub on 
the head of the penis and the skin near it, a little of the dust of 
calomel, or apply mercurial ointment. It should be done be- 
fore, but will be likely to succeed afterwards: because it has 
been found that pox matter, when mixed with calomel or mer- 
cury and then introduced under the skin, as in innoculation, 
will not produce the disease. Washing the parts instantly 
after with soap suds, or with lye, spirit and water, or the urine 
alone, I believe would generally succeed. The introduction of 
calomel into the female parts, or freely washing them, will have 
a similar effect. Certainly it would be better for all people to 
refrain from illicit intercourse: but as preaching against it for 
the last four thousand years, has been unavailing; it is better 
to lessen the evils by using the preventives of this loathsome 
disease. 



ASTHMA. 

This disease is an affection of the lungs, which comes on by 
fits, most generally at night, and is attended by a frequent, dif- 
ficult, and short respiration, together with a wheezing noise, 
tightness across the chest, and a cough; all of which symp- 
toms are much increased when the patient is laying down. 

Asthma rarely appears but in grown persons, and seems to 
attack men oftenerthan women, particularly those of a full ha- 
bit, in whom it never fails, by frequent repetition, to occasion 
some degree of emaciation. Indigestion always prevails, and 
appears to be a prominent feature in the predisposition. Its 
attacks are more frequent during the heats of summer: and in 
winter, when heavy fogs and strong cold winds prevail. 



391 

When the disease is attended with an accumulation and dis- 
charge of humours from the lungs, it is called the humid asth- 
ma; but when it is not attended by expectoration, it is called 
the dry or spasmodic asthma. 

On the evening before an attack of asthma, the spirits of the 
patient are much affected, and he feels a sense of fulness about 
the stomach, with lassitude, drowsiness, and a pain in the head. 
On the approach of the succeeding evening, he perceives a 
sense of tightness and stricture across the breast, and a sense 
of straightness in the lungs, impeding respiration. The diffi- 
culty of breathing continuing to increase for some length of 
time, both inspiration and expiration are performed slowly, 
and with a wheezing noise; the speech becomes difficult and 
uneasy; a propensity to coughing succeeds; and the patient can 
no longer remain in a horizontal position, being, as it were, 
threatened with immediate suffocation. 

These symptoms usually continue till towards the approach 
of morning, and then a remission commonly takes place: the 
breathing becomes less laborious and more full; and the person 
speaks and coughs with greater ease. If the cough is attend- 
ed with an expectoration of mucus, he experiences much relief, 
and soon falls asleep. 

When he awakes in the morning, he still feels some degree- 
of tightness across his breast, although his breathing is proba- 
bly more free and easy; and he cannot bear the least motion 
without rendering this more difficult and uneasy; neither can 
he continue in bed, unless his head and shoulders are raised to 
a considerable height. 

Towards evening, he is again drowsy, is much troubled with 
flatulency in the stomach, and perceives a return of the diffi- 
culty of breathing, which continues to increase gradually till it 
becomes as violent as on the night before. 

After some nights passed in this way, the fits moderate, and 
suffer more considerable remissions, particularly when they are 
attended by copious expectoration in the morning. This con- 
tinues from time to time throughout the day; and the disease 
going off at last, the patient enjoys his usual rest at night, with- 
out further disturbance. 



During the fits, the pulse is not usually much affected; but 
in a few cases, there is a frequency of it, with some degree of 
thirst, and other feverish symptoms. In some persons, the 
face becomes turgid and flushed, during the continuance of 
the fit, but more commonly is pale and shrunk. Urine voided 
at the beginning of a fit, is generally in considerable quantity, 
and with little colour or odour; but after the fit is over, what 
is voided is in the ordinary quantity, of a high colour, and 
sometimes deposits a sediment. 

Asthma is brought on by almost every thing which can in- 
crease the action of the heart, and which stimulates and fills the 
vessels of the mucus membranes of the lungs. Thus a fit may 
be produced by heat, lightness of air, severe exercise, strong 
mental emotions, full meals, stimulating drinks, exposure to 
severe cold, and by certain effluvia, as those of hay, whether 
new or old, of sealing wax, and other burning substances, &c. 
In some instances, it proceeds from an hereditary predisposi- 
tion; and in others, from mal-conformation of the chest. 

The immediate cause of the disease has, by Dr. Cullen and 
most other writers, been supposed to be a preternatural or 
spasmodic construction of the muscular fibres of the windpipe, 
which prevents its being so dilated as to admit of a free and 
full inspiration, and gives a rigidity which interferes with a 
free and full expiration. The mucus which is excreted in the 
course of the disease, has been looked upon by Dr. Cullen as 
only an effect of the disease; but others believe it to be the 
prominent cause of the fit. 

. Asthma usually diminishes as soon as a mucus secretion be- 
gins to take place in the lungs, and is more speedily and effec- 
tually relieved by a spitting of blood. These are convincing- 
proofs of a preternatural fulness of the vessels of the mucus 
membrane of the lungs, so as to impede free respiration, and 
to produce all the symptoms of spasmodic asthma. 

The sudden accession of the fits, generally after the first 
sleep; their, returning at intervals; the sense of constriction 
about the chest, occasioning the patient to get into an erect 
posture, and to fly for relief to the cold air; will readily distin- 
guish asthma from other diseases. 



393 

In the treatment of asthma, we should endeavour to mode- 
rate the violence of the fits, and when they are subsided, to hin- 
der their recurrence. With the' 'view of preventing any dan- 
ger from the difficult transmission of blood through the lungs, 
and of obviating the full state of the system, which might 
be supposed to have a share in producing a turgescence of the 
blood in the lungs, it is a frequent practice to draw off blood 
during the fit; but bleeding has proved highly injurious in al- 
most every instance of the disease, by delaying the expectora- 
tion, and is certain to be attended with bad consequences, 
where asthma has arisen in elderly persons, or has been of long 
standing. In full, strong habits, possibly cupping or the ap- 
plication of leeches to the chest, might afford relief. 

To moderate the severity of the fits in asthma, we cannot 
employ a more powerful mean of relief, than the inhaling of 
warm steam, frequently, from the spout of a tea pot. An infu- 
sion of chammomile flowers, with the addition of a little ether, 
may be used on the occasion. 

In spasmodic asthma, smoking tobacco has in some cases 
proved very beneficial. The tincture of fox-glove, in repeated 
doses, has been recommended, with or without half a grain of 
opium. Some have found'great relief in smoking the leaves of 
the Jamestown weed. 



RHEUMATISM. 

This disease is divided into the chronic and the acute: 
being known by the former appellation when there is no great 
degree of inflammation or fever, but merely pains; and by the 
latter when both fever and inflammation exist. 

It may arise at all times of the year; but the Spring and Au- 
tumn are the seasons in which it is most prevalent. It attacks 
persons of all ages, but very young people are more exempt 
from it than adults. Those whose employments subject them 
to exposures to great heat and cold, are particularly liable to 
Rheumatism. 



% z 



394 

Obstructed perspiration, occasioned by wearing wet clothes^ 
lying in damp linen, sleeping on the ground, or by being expos- 
ed to cool air when the body has been heated by exercise, or 
by coming from a crouded room into the cool air, is the cause 
which usually produces Rheumatism. Those who are much 
afflicted with this complaint, are very apt to be sensible of the 
approach of wet weather, by wandering pains about them at 
that period. 

Chronic Rheumatism is attended with pains in the head,, 
shoulders and other large joints, which at times are confined to 
one particular part, and at others shift from one joint to ano- 
ther without occasioning any inflammation or fever; and in this 
manner the complaint continues often for a considerable time* 
and at length goes off, leaving the parts which have been af- 
fected in a state of debility, and liable to fresh impressions on 
the approach of bad weather. 

In the treatment of acute Rheumatism, it is necessary to ob- 
viate the general inflammation which prevails: and this is to 
be effected by mild diet and drinks; by blood-letting when there 
is a fulness of the pulse, the constitution robust, and the heat 
considerable, — proportioning the quantity we ta£e away, to the 
violence of the symptoms, and the age, strength,, and habit of 
the patient. If the pains continue very severe, and the pulse 
full, hard, and quick, after bleeding; and the blood appears 
very sizy on becoming cool, we may with great propriety re- 
peat the bleeding either on the same day or the next; but this 
mode of proceeding should be adopted only at an early period 
of the disease, and never carried to an extent endangering ex- 
treme debility. Sometimes the violence of the fever has been 
much lessened, by giving from ten to twenty drops of the tinc- 
ture of fox-glove every four or live hours; and this may render 
any repetition of bleeding unnecessary. Purging should be 
carried to an extent equal to that of bleeding, and one or two 
evacuations should be procured daily in all cases, by making 
use of some mild laxative, such as the neutral salts, &c. or by 
giving clysters. 

When the pain is chiefly confined to one part, and is not at- 
tended with much inflammation, blistering may be serviceable. 



395 

The part should be anointed with some kind of liniment — such 
as two ounces of camphorated spirits with half an ounce of vo- 
latile alkali, or three ounces of olive oil mixed with one of oil 
of turpentine and fifteen drops of sulphuric acid; or spirit of 
hartshorn or of turpentine alone, will prove serviceable. But 
where the pains are wandering, neither of these remedies will 
be of much use. In acute rheumatism, warm fomentations 
ought never to be employed: as they are found to aggravate the 
pains, rather than relieve them. 

When any of the joints of the extremities swell very much, 
and are highly painful; besides drawing blood from the part 
with leeches, or by cupping, a blister is to be applied over the 
whole joint, or it is to be rubbed with tincture of Spanish flies 
and the volatile alkali, mixed in equal parts. One pound of 
rye flour mixed with four ounces of stale beer or vinegar and 
two ounces of muriated natron, made into paste with hot water 
and applied to the part affected, — to be renewed morning and 
evening — Dr. Thomas states has often relieved the pain. 

The reduction of heat by keeping linen cloths wetted in cold 
water, or a solution of crude sal ammoniac with a little salt pe- 
tre, constantly to the inflamed parts, may be adopted with 
safety and much advantage in acute rheumatism; although in 
gout, to which the disease is so nearly allied, the remedy is 
hazardous. Sweating is frequently resorted to, both in the 
acute and chronic rheumatism, and often with great success; 
but it has its inconveniences: for sometimes it comes out freely 
without producing any good effect, and when long continued, 
it relaxes the skin and makes the patient susceptible of cold; 
to guard against which, it will be necessary for him to be con- 
fined to his chamber and to wear flannel next his skin. Small 
doses of tartar or Dover's powders, repeated, are the best 
means to excite sweating. In acute rheumatism, the patient 
must be kept on a cool spare diet, as milk, whey, buttermilk, 
light vegetable matters, panado, ripe fruits, Sec; animal food 
and fermented liquors should be avoided. 

The chronic rheumatism must be treated in a different man- 
ner: here, bleeding from the system will not be proper: nor 
need there be any change in the diet of the patient. 



396 

Where the parts about the joints are the seat of the dis- 
ease, or an enlargement of the extremities of the bones has 
taken place, the first attempt at relief should be by local 
bleeding, either by the application of leeches or by cupping. 
When the pain and irritation are abated by this operation, a 
drain should be secured from the part by the aid of issues, 
kept open by the daily application of weak ointment of Span- 
ish flies or with caustic. 

Exposure of affected parts to the hot vapour of water, some- 
times of vinegar, for an hour or two, has done great good. It 
is to be daily repeated. 

In most cases it will be adviseable to rub the parts where the 
disease is seated, several times a day, with some of the irrita- 
ting liniments recommended, after which they are to be wrap- 
ped up in flannel. The regular use of a flesh brush, with elec- 
tricity, or galvanism, is often of service in cases of long stand- 
ing, and where there is any rigidity of the parts. Rubbing 
the part with a ball of cotton., has been done with great advan- 
tage: it generates electricity on the surface. 

Exercise is highly important, either of the whole body, or 
of particular limbs; and indeed the want of it is apt to induce 
stiffness in the parts affected. 

Frictions with ether, or camphor dissolved in ether, on the 
painful parts, have been found highly beneficial. Warm bath- 
ing or pouring warm water upon the limb from a kettle seve- 
ral times a day, has in many instances proved very serviceable, 
together with proper exercise when the patient is capable of 
taking it. The patient may remain in the warm bath from 
twenty to sixty minutes: and when in it, his skin should be 
well rubbed with a hair brush. The temperature of the bath 
may be varied at pleasure from ninety to one hundred degrees. 

Cold bathing has been advised by some Physicians, while 
others, have disapproved of it. It certainly has in some cases 
proved salutary. The cold bath is a stimulant, and promotes 
perspiration, and by strengthening the body prevents a relapse: 
But it is not to be used, where there are any feverish syrup* 
toms. 



31)7 

The shower bath with subsequent frictions and warm cloth- 
ing, will be found not only a successful mean of cure in many- 
cases of chronic rheumatism; but also a very effectual preven- 
tive. Some tonics, internally given, have proved serviceable 
in prevention. 



OF THE GOUT. 

Upon this subject, Dr. Rush, with his usual accuracy of ob- 
servation, states that it is a disease of the whole system, affect- 
ing- occasionally every part of the body. The idle and luxuri- 
ous are most subject to it — women as well as men. It is in 
some cases a hereditary disease, more frequently received from 
the father than the mother. The remote causes are indolence, 
great bodily exertion, intemperance in eating and venery, acid 
food and drinks, strong tea and coffee, vexation, violent pas- 
sions, study, business, or pleasure, and most frequently the use 
of ardent and fermented liquors. 

It generally makes its first attack in the night, and in the 
parts most remote from the heart, especially the big toe. It is 
a disease analogous to fevers, attended with irregular action in 
the blood-vessels. 

The ligaments which connect the bones, are the seats of what 
is called the legitimate or true gout. They are affected with 
pain, swelling, and inflammation: the pain being sometimes so 
severe as to be compared to the gnawing of a dog. Dr. Rush 
says that it is the same disease with the rheumatism. These 
diseases are produced by different remote causes: but this con- 
stitutes no more difference in their nature, than is produced in 
a coal of fire, whether it be inflamed by a candle, or a spark 
of electricity. Each disease is frequently marked by a chalky 
secretion in the joints, and actual dislocations of the joints. 
He compares the gout to a monarch whose empire is unlimit- 
ed: the whole body crouches before it. It affects different 
parts of the body in different people, according to the nature 
of their predispositions; and it often passes from one part to 
another in the twinkling of an eye, 



398 

The remedies for the gout, Dr. Rush divides under the fol- 
lowing heads: 

1. Such as are proper in its forming state. 

5. Such as are proper in violent morbid action of the blood- 
vessels, and contents of the brain, chest, and belly. 

3. Such as are proper in a feeble morbid action in the same 
parts of the body. 

4. Such as are proper to relieve certain local symptoms. 

5. Such as are proper to prevent its recurrence. 

The symptoms of an approaching fit of the gout, are great 
languor and dulness of body and mind, doziness, giddiness, 
wakefulness, disturbed sleep, a dryness, and sometimes a cold- 
ness, numbness and prickling in the feet and legs, a disappear- 
ance of pimples in the face, occasional chills, acidity and flatu- 
lency in the stomach, with an increased, a weak, or defective 
appetite. Sometimes the urine becomes sour. In this state of 
the disease, it may be readily prevented by losing a few oun- 
ces of blood, or taking a purge and bathing the feet in warm 
water, by a dose of the spirit of hartshorn, by a draught of 
wine whey, or a common dose of laudanum. 

The remedies proper in cases of great morbid action, are 
blood-letting — and it should be carried to an extent equal to the 
violence of the attack, in order to lessen the pain and conges- 
tions which produce apoplexy, palsy, inflammation of the kid- 
neys and bladder, the gravel, and chalk stones in the hands and 
feet. Free purging is no less necessary: and it may be made 
by sulphur, oils, cream of tartar, jalap, or calomel. Salts are 
generally offensive to the stomach. Vomits may be given in 
all cases where bleeding is objected to. Nitre in common do- 
ses may be administered. Diluting liquors, such as are pre- 
scribed in common fevers, should be taken; cold air should be 
admitted to the parts inflamed; abstinence from all that is heat- 
ing should be enjoined. Blisters are an invaluable remedy in 
this disease, after the reduction of the morbid action by evacu- 
ations; they are to be applied to the joints of the feet and wrists 
in general gout, and to the neck and sides when it attacks the 
head or breast. The principal advantage of blisters is derived 
from their collecting and concentrating scattered and painful 



399 

sensations, and conveying them out of the system. Fear and 
terror have sometimes cured the disease in a few minutes. Dr. 
Rush further adds that sweating is injudicious, unless it be 
from giving the Seneka snake root. Opium may be given in 
small doses after the violent action is reduced. 

To moderate the pain, if blisters be objected to, a cabbage 
leaf has done good, and also bathing the part with molasses. 
The sooner a patient exercises his lower limbs, by walking, af- 
ter a fit of the gout, the better; as it will prevent the stiffening 
of the joints. 

In cases of feeble action in the system, an opposite treatment 
is necessary; opium, wines, porter, and ardent spirits are pro- 
per. In some cases a pint of spirit has been given, with ad- 
vantage, in the course of an hour. Large doses of ether may 
be tried; . volatile alkali and all the aromatic substances; also 
the oil of amber, and Peruvian bark if the stomach will retain 
it. — Frictions should be tried, with brandy and the volatile 
liniment. The warm bath is proper; as also exciting saliva- 
tion. 

The headach is a distressing symptom, and is to be relieved 
by cupping, and cold applications to the head and blisters be- 
hind the ears. Persons have been cured by sleeping with the 
head covered with flannel. Dull, but constant, pains in the 
limbs yield to frictions with balls of cotton or wool, volatile 
liniments, wearing flannel next the skin, electricity and galvan- 
ism. Rubbing the limbs with castor oil, and wrapping them 
up in hot sand, have been useful; also, taking two or four tea 
spoonsful of the spirit of turpentine every morning, mixed with 
three times the quantity of honey, for eight or ten days, and 
each night to be followed by an anodyne. J± gouty diarrhoea 
should be treated as one from any other cause. Spasms in 'the 
stomach and pains in the bowels, often seize gouty people very 
suddenly; for which ten or twenty drops of laudanum may be 
given, with hot toddy or spiced wine. The piles are not an 
unusual attendant, and are to be treated as when arising from 
other causes; as also eruptions of the skin. But in treating all 
local affections from gout, care should be taken to ascertain if 
they did not relieve affections of more vital parts, in which 



400 

case threat caution should be observed, and counter irritations 
produced in the system. 

The predisposition to gout is best overcome by very mode- 
rate living; and great industry; avoiding exposure to cold: the 
passions should not be freely indulged, especially the venereal; 
costiveness ought always to be corrected, and sulphur is es- 
teemed the best laxative. Issues have sometimes succeeded. 
A change of diet, removal to warmer climates, the use of the 
preparations of iron, and the warm bath, will be found service- 
able in giving a permanent tone to the system, to prevent re- 
turns of this painful disease. 



INFLUENZA. 

The symptoms of influenza are, a hoarseness, sore throat, a 
sense of weariness, chills and fevers. It is sometimes attended 
with acute pains in the head, soreness of the eyes, and swelling 
of the eye-lids, and a copious effusion of water from the eyes. 
Sneezing is a most general symptom, and the matter discharg- 
ed from the nose frequently is so acrid, as to inflame the nos- 
trils and upper lip. Difficulty of breathing, considerable cough, 
and pains in the breast and sides, are frequent attendants on 
this complaint. The limbs are sometimes so affected, as to re- 
semble rheumatism. The pulse is sometimes quick and hard. 

The treatment is the same as in all fevers, to be regulated by 
the state of the system. In cases where there appears much 
symptoms of inflammation, bleeding and purging are proper. 
Where the symptoms are not distressing, a moderate vomit 
will suffice. Small doses of laudanum, with a quarter of a grain 
of tartar emetic, are proper to lessen the cough. A mixture 
of ten grains of the vegetable alkali in a tea cup of a solution 
of liquorice in water, will be found of service in lessening the 
cough, with a few drops of laudanum. The diet should be 
mild; and in its worst stages, the patient should be confined to 
the house, and occasionally bathe his feet, and breathe the 
steam of water, with or without vinegar. In short, the disease, 
in its general form should be treated as a common cold; de- 



401 

pending on no states of the weather, and more rapid than any 
other in spreading over the most extensive countries. 



COLD AND CATARRH. 

The inhabitants of every climate are liable to cold at differ- 
ent seasons of the year, particularly when the changes of the 
surrounding atmosphere are sudden, and of considerable ex- 
tent. The persons most subject to this disease, are those of 
delicate and irritable constitution, and whose employments ex- 
pose them to great transitions from heat to cold. 

A cold is attended with a weight or uneasiness in the head, 
fulness and oppression at the chest, a sense of distension and 
stopping up of the nose, followed by a secretion of mucus from 
the watery, inflamed eyes; soreness of the throat; cough, with 
expectoration of mucus; cold shiverings, succeeded by tran- 
sient flushes of heat, and pain in different parts of the body, 
very frequently the chest. 

This disease is not generally attended with danger, when ap- 
pearing under a mild form, and early precautions are used. — 
If the symptoms should be highly inflammatory, and the con- 
stitution of the patient delicate and irritable, the most vigilant 
attention is demanded, in order to arrest the progress of the 
disease; otherwise the most serious consequences may ensue. 
It is by such neglect that two-thirds of the cases of consump- 
tion and other pulmonary affections, in this country, arise. 

When a person finds himself much indisposed from expo- 
sure to cold, he should at once confine himself to the house; 
use a spare, mild diet; drink barley water with lemon juice in 
it, or any other warm diluent, or mucilaginous drinks, and par- 
ticularly avoid eating or drinking any thing stimulating to the 
stomach. Previous to going to bed, put the feet in warm wa- 
ter, and take warm whey or some other sweating draught; the 
warm bath may also be applied with great advantage to the 
face, and hot vapour breathed into the nostrils; after which, 
the head should be kept warm during the night: by this means, 
the uneasiness in the head and stopping up of the nose are of- 
A a a 



40£ 

ten effectually relieved. If the bowels should be costive, it will 
be necessary to take some gentle laxative medicine every day. 
When the symptoms do not yield to this treatment in a few 
days, and the cough, breathing, or pain in the chest, should in- 
dicate inflammation, it will be necessary to draw blood in pro- 
portion to the urgency of the symptoms, to keep up the evacu- 
ations from the bowels, and to give sweating medicines. The 
antimonial preparations should always be preferred; they not; 
only produce perspiration, but possess a peculiar power of 
calming the excitement of the system. 

If these means should not relieve the uneasiness in the chest, 
it will be adviseable to apply a large blister over the breast, and 
to keep' up the irritation and discharge from it as long as the 
cough and uneasiness in the chest continue. 

After the inflammatory symptoms have subsided, the irrita- 
tion producing the cough may be allayed by opium, conjoined 
with antimony; laudanum and antimonial wine is a good com- 
bination, taken in warm tea; Dover's powder, in doses of five 
grains, is also an excellent form of exhibiting an anodyne in 
this stage of the disease. 

This disease differs very little from influenza, excepting that 

it is not contagious. The treatment, in short, is much the 

i 
same, to which subject you will refer. 

I have to remark, that a remedy of no common efficacy is 
scorching the feet before the fire every night. This should be 
done so long as it can be borne without too much pain. They 
should frequently be held to the fire, and cooled; thereby a de- 
termination of blood and action will be directed to them.— 
Scalding in equal degree the feet in strong lye, is a good sub- 
stitute. A violent fit of coughing is frequently relieved, as in 
the hooping coughy by pouring a tea spoonful of warm oil or 
melted lard at the back of the throat. One of the most com- 
mon cough drops is made of one ounce of liquorice, dissolved 
in a quart of boiling water, to which is to be added one ounce 
of antimonial wine, and two ounces of paregoric, or near half 
the quantity of laudanum; a wine glass full to be taken on going 
to bed. Wearing a large pitch plaster on the side, will be found 
serviceable. 



403 



A CONTINUED COMMON COUGH. 

This is generally the effect of a cold neglected, or improper- 
ly treated. Sometimes it arises from indigestion, or irritable 
matter in the stomach and bowels. 

A common cough ought always to be viewed as a serious 
disease, and should never fail to excite the fear and anxiety of 
the patient and friends. By early and vigilant attention to 
this disease, thousands of lives might be saved, which other- 
wise are destroyed by pulmonary consumption. When a cough 
is troublesome, accompanied by pain or oppression about the 
chest, and dry skin, without coughing up mucus, it will always 
be adviseable to take blood from the arm until the pulse is re- 
duced, or some impression is made on the system. If the fee- 
bleness of the constitution should forbid this, cupping the sides 
freely should be done, or twenty or thirty leeches applied to the 
chest, followed by a blister on the back or side, which will ge- 
nerally produce the desired effect. When much mucus is spit 
up freely, attended with a moist skin, it would not be adviseable 
to resort to bleeding. 

If the expectoration is scarce, or impeded by tough phlegm, 
and attended by a hot, dry skin, the best medicine which can 
be given, after bleeding, is the tartar emetic, in doses of a quar- 
ter or half a grain, exhibited in warm mucilaginous drinks, and 
repeated every two or three hours, unless it should excite puk- 
ing or purging: in either case, a few drops of laudanum will 
check the operation, and also tend to calm the irritation pro- 
ducing the cough. James's powder, or its substitute, the anti- 
monial powder, given in doses of three or five grains, every 
three hours, is also an important remedy, and not apt to excite 
vomiting. Sometimes a cough is brought on, and kept up, Ay a 
deranged state of the digestive organs; and unless the remedies 
are directed to them, our efforts to cure the crease will 
prove unavailing. Great attention should be paid to the diet in 
general, and the drinks should be of the miHest kind, and best 
suited for the habits of the subject. AA spirituous or stimu- 
lating drinks, should be prohibited. Sometimes drinking au 



404 

acid, sometimes an alkali, will afford relief. Lime water is a 
good substitute for the latter. I refer you to all the articles 
under the head of indigestion, for the treatment of cases aris- 
ing from defect in the powers of the stomach. 

Whenever the cough is a symptomatic affection of other dis- 
eases, in all such cases we should direct our remedies to the 
original seat of disease; and here, the advice of an experienced 
physician should always be requested. 

Some persons are subject, during different seasons of the 
year, to a chronic or habitual cough, attended with shortness 
of breath, wheezing, and an expectoration of tough phlegm.—- 
In all such cases, the mixture of gum ammoniac with syrup of 
squills, and elixir paregoric, taken occasionally during the day 
and night, may be used with advantage, particularly when aid- 
ed by breathing the vapour of vinegar and water, spirit of cam- 
phor, or any other mildly stimulating vapour. A poultice of 
onions, with a little mustard, or of any other stimulating kind, 
applied over the chest, will also prove valuable auxiliaries; as 
well as garlic to the feet, and very hard rubbing of the extremis 
ties. 

There is certainly much repetition on the subjects of a con^ 
tinued common cough, colds and catarrhs, and influenza; but 
there is not too much of it, if it will induce all subject to affec- 
tions of the breast, especially those of narrow chests and long 
necks, whenever having any of the varieties of such complaints, 
to pay very serious attention to them until they are relieved. — 
They end so often in consumption, that no one should neglect 
them; nor can I too often urge you, in all such cases, to relieve 
the lungs by determination to the surface, by cupping, blisters, 
frictions, and riding on hard trotting horses, when there is no 
fever. 



CONSUMPTION. 

I shall continue to extract from Dr. Rush on this subject. It 
is a disease induced \>y predisposing debility, and is a primary 
disease of the whole system. The remote and exciting causes 



405 

are, inflammatory affections of the lungs, rheumatism, gout, 
scrofula, affections of the stomach, liver, and kidneys, fevers, 
repelled irritations from the surface of the body, the venereal 
disease, sudden growth about the age of puberty, all weaken- 
ing passions of the mind, excessive evacuations of all kinds, 
particularly by spitting from the smoking and chewing of to- 
bacco, and by stool, exposure to cold and damp air, extreme 
violence on the body; and, to conclude, all that tends to dimin- 
ish the strength of the system. 

Consumption frequently alternates with others, as rheuma- 
tism, gout, madness, the womb in pregnancy, headach, indi- 
gestion, eruptions of the skin, affections of the bowels, &c. It 
is not of a contagious nature, but is common in families inher- 
iting the predisposing debility. 

The cure of consumption should always be attempted in its 
forming state, before it produces the active symptoms of cough, 
blood, or rather matter from the lungs, or inflammatory or hectic 
fever. The symptoms marking its first stage are seldom ob- 
served, and if observed, too much neglected. They are a slight 
fever, increased by the least exercise; a burning and dryness in 
the palms of the hands, more especially towards -the evening; 
running eyes upon waking from sleep; an increase of urine; 
a dryness of the skin, more especially of the feet, in the morn- 
ing; an occasional flushing in one, and sometimes in both 
cheeks; a hoarseness; a slight or acute pain in the breast; a 
fixed pain in one side, or shooting pains in each side; headach; 
occasional sick and fainty fits; a deficiency of appetite; and a 
general indisposition to all exercise or motion. 

The remedies for this stage of the disease, are simple and 
certain. They consist in an abandonment of all its remote 
causes, as sedentary employments, damp Or cold situations, 
and whatever tends to weaken the system. Dr. Rush has, 
with great benefit to his patients, in this stage, prescribed the 
cold bath, steel, and bark; which would prove injurious when 
the system assumes an inflammatory or hectic state. To these 
remedies are to be added a diet moderately stimulating, and 
such gentle exercise as keeps all parts of the body in motion. 



406 

If these simple means are not resorted to, consumption will 
show itself in one of the three following forms: 

1. A fever, accompanied with a cough, hard pulse, and a dis- 
charge of blood or mucus from the lungs. 

2. A fever, of the hectic kind, accompanied by chilly fits, 
and night sweats, with a pulse full, quick, and occasionally 
hard. The discharge from the lungs in this state of the dis- 
ease is usually matter. 

3. A fever, with a weak and frequent pulse, a troublesome 
cough, and copious purulent discharges from the lungs, a 
hoarse and weak voice, and chilly fits and night sweats alter- 
nating, with a looseness of the bowels. 

For the inflammatory state, the first most important remedy 
is blood-letting. Dr. Rush states cases in which this has been 
done with most incredible frequency. It is most adviseable to 
take small quantities at a time, and repeat it often— as often as 
the patient is found with tense or hard pulse. 

Mild diet, consisting chiefly of milk and vegetables, is to be 
preferred — to be eat four or five times in the day. Vomits 
have been recommended very highly, to be repeated once or 
twice a week where bleeding is objected to. Exercise, by 
walking in cool and dry air, is to be taken. 

For the hectic state of consumption, Dr Rush observes the 
treatment must depend on the varying state of the system, 
which changes in a few days from high to low action. Bleed- 
ing in small quantities may be made, when the pulse is hard 
and there is severe pain in the side. The common tonics may 
be taken when the system is reduced. 

For the low or nervous state in this disease, stimulating me- 
dicines are requisite: opium is very necessary; garlic, a strong 
tea of horehound, doses of oil of amber and of turpentine, of 
the balsams and bitters of all kinds, may be administered. The 
Peruvian bark is of most service to those whose consumption 
arises from the ague and fever. Not less necessary, is a dif- 
ferent diet. — Instead of milk and vegetables, it should consist of 
cordial and stimulating food — of which, the best will be that to 
which the patient is most accustomed. 



407 

The palliative remedies above mentioned, may be aided in 
each state of the system by selecting a dry situation; by coun- 
try air, change of climate, loose dresses and a careful accom- 
modation of them to the changes in the weather. Evacuations 
by means of blisters and issues on parts affected previous to the 
disease from gout and rheumatism; sleeping between blankets 
in winter, and mattresses in summer; the moderate use of the 
lungs in reading, singing, speaking, and laughing; the passions 
of fear and terror, and salivation; have each aided in some in- 
stances, in effecting a cure. 

The distressing cough in this disease, is to be mitigated by 
the common mucilaginous drinks, by opiates, by vapours from 
pouring boiling water on tar and bran, the most easy position 
of the body, and by silence. 

For the night sweats, drinks of the elixir vitriol, of the nitric 
acid, of lime water, or of water-mellon seed tea, are recom- 
mended. 

For the looseness, the same remedies should be given which 
are prescribed under the head of looseness or diarrhcea, as an 
original disease. Chalk and laudanum in mucilage, are pre- 
ferred where acidity exists in the stomach. 

The radical remedies for consumption are: exercise, hard- 
ships' of a camp or naval life. Many have been relieved by 
the labours of cutting wood which excites action on the breast; 
rocking in a cradle, swinging, sailing, riding in carriages, and 
on horse back, walking, running and dancing, have severally 
relieved, when taken each in such succession and degree, as 
are adapted to the state of the patient. The more the arms in 
general are used the better. In consumption of long continu- 
ance, or of great danger, long journeys on horse back, are the 
most effectual modes of exercise. The patient should avoid 
fatigue and travelling too soon in the morning: and if he rests 
in the day, he should undress as at night and avoid damp bed- 
ding: avoid large or night companies; guard against the ex- 
tremes of heat or cold. The journey should be pursued for 
twelve months at least, and repeated every two or three years/ 
Many ride every day, more or less. 



408 

The above is an epitome of Dr. Rush's thoughts and direc- 
tions on the subject. I have to add, that I believe it is as much 
a disease of the skin as of the lungs. We are forcibly struck 
with the appearance of all consumptive persons — their skin 
shrivelled and altered in colour. I would recommend powerful 
frictions on the surface, and dry cupping the body from head 
to foot: commencing with one-fourth of it, and continuing it 
daily in equal proportion, and to be renewed as long as the dis- 
ease lasts. A more effectual mode of cupping will be found by 
using an air pump, attached by a bladder to a tin tube large 
enough to receive the limb, if not half the body. Wet bladders 
can easily be applied to the limb and tube, so as to exclude the 
external air, while that of the interior can be extracted as long 
as it can be borne. I have had such a contrivance made at a 
moderate expense: and would strongly recommend the use of 
such a one, as I have found great good from it, in some inter- 
nal affections — though have never tried it in consumption. 

After the above was sent to the press, I received the subjoin- 
ed on the subject, from Dr. Henry Huntt, formerly Hospital 
Surgeon of the late United States' Army, and now extensively 
engaged in the practice of physic in the city of Washington. 
Although there are some remarks in it which will be found in 
the above, it contains something original and important; and 
my anxiety on this subject induces me to insert the whole. 

This disease is known by a wasting of the body, attended 
with a cough, difficulty of breathing hectic fever, and general- 
ly with a spitting of purulent matter, either from turbercles, 
(small tumours) or abscesses in the lungs. Sometimes a gene- 
ral inflammation of the mucus membrane of the lungs, will pro- 
duce this discharge. Pulmonary consumption is a most insi- 
dious disease, and steals on so gradually, that no alarm or un- 
easiness is excited until it makes considerable progress, and the 
constitution is generally impaired. The patient at first be- 
comes languid and gradually loses strength; the breathing is 
hurried by the least bodily exertion; the pulse becomes small, 
and quicker than natural; and at length, from any little expo- 
sure to cold, or other exciting causes, the breathing is more 



409 

copious, a sense of tightness and oppression at the chest are 
experienced; the cough becomes more troublesome, particularly 
during the night; an expectoration of frothy mucus takes place, 
which is usually most considerable in the morning, and after- 
wards becomes more copious, viscid, and opaque. 

As the disease advances, a pain is perceived in the chest, or 
one of the sides, which is increased by laughing, and the pati- 
ent is sometimes unable to lay on the affected side. The face 
now flushes; the pulse is quick and hard, frequently amounting 
to 120 strokes in a minute; the urine is high coloured, and de- 
posits a muddy sediment; the palms of the hands and soles of 
the feet are affected with burning heat; the tongue, from being 
at first white, is now clean, but red; and purulent matter is 
spit up from time to time, by coughing. The symptoms in- 
crease considerably towards evening, and the fever now as- 
sumes the hectic form, having an aggravation of its symptoms 
twice a day: the first about noon, wbich is inconsiderable, and 
soon suffers a remission: the other in the evening, which in- 
creases gradually, until after midnight. Each increase of 
feverish symptoms is usually preceded by some degree of 
shivering, and terminates in profuse perspiration. 

During the fever, a redness generally appears on each cheek; 
but at other times, particularly when the disease arises from 
a deranged state of the digestive organs, the face is pale, the 
countenance dejected, and the white part of the eyes assume 
a placid, pearly appearance; general emaciation takes place, 
the cheek bones are prominent, the eyes hollow and languid, 
the whole countenance assumes a cadaverous appearance, the 
nails are incurvated, and of a livid colour, the legs swell, and 
the mouth and throat are affected with the thrush. About 
this time a purging generally comes on, which frequently 
alternates with profuse sweating. Still, however, the appetite 
often remains good, and the patient has a craving for solid 
food, from which circumstance, he is apt to flatter himself 
with the hope of a speedy recovery, and often vainly forms dis- 
tant projects of amusement, or interest, when at last death 
{doses his existence. 



B b b 



410 

The time persons are most liable to this disease, is generally 
between the fifteenth and thirty-fifth year of age; but no stage 
of life, from infancy to old age, is exempt from it. 

Consumption is readily distinguished from all other diseases 
by the hectic fever and free expectoration which attend it.— • 
Pure purulent matter is opaque, of a foetid odour, of greater 
specific gravity than water, as when put into it, it sinks to the 
bottom of the vessel. Its colour is either white, yellow, or 
green; when dissolved in sulphuric acid, if water be added, it 
either falls to the bottom, or forms an intimate mixture, mak- 
ing the whole uniformly turbid. 

Mucus is transparent, viscid, not mixable with water, and it 
does not smell; upon adding water to its solution in sulphuric 
acid, it separates into small flakes and floats upon the surface. 
Such are the tests by which any person may readily distinguish 
the difference between purulent matter and mucus when expect- 
to rated. « 

In the treatment of pulmonary consumption, our success 
mainly depends on the early and persevering application of the 
remedies; whenever there is cough, accompanied by pain or 
uneasiness in the breast or either of the sides, with febrile 
symptoms, our suspicions should be immediately roused, and 
our unremitted attention directed to the complaint, particular- 
ly if the. constitution of the patient is delicate and irritable, or 
he should possess any predisposition to this disease, either 
from ancestors or from any other cause. In the first place, the 
patient should lose blood, and the quantity taken should be re- 
gulated by the strength of the constitution and habits of the 
patient. This operation should be repeated every two or three 
clays until the symptoms are arrested. The most abstemious 
diet should be rigidly enforced; the bowels should be kept mo- 
derately laxative; and in order to calm the cough, fever, and 
irritation of the system, some antimonial preparation should 
be administered in warm mucilaginous drinks, and repeated 
every two or three hours. In all such cases, the tartar emetic 
should be preferred, in doses of half a grain, to be gradually- 
increased until the symptoms shall abate. If it should affect 
the stomach or bowels, add a few drops of laudanum to each 



411 

dose. This medicine, by proper precautions, may be increased 
considerably, with great advantage, in this stage of the disease. 
When the inflammatory stage is reduced, blistering the breast 
and sides, also cupping, will prove of great importance; but to 
ensure their full effect, the irritation and discharge they pro- 
duce should be kept up for a considerable time. The sulphate 
of copper (blue vitriol) is sometimes a proper and efficacious 
remedy, given in doses of one or two grains united with a grain 
of ipecacuanhae and the same quantity of rhubarb, made into a 
pill, and repeated two or three times a day, agreeably to the 
effects. Should the cough be troublesome at night, the pa- 
tient should inhale vapour arising from warm water, with a lit- 
tle vinegar added to it, and afterwards take five or six grains of 
Dover's powder, or twenty drops of laudanum with the same 
quantity of antimonial wine, mixed in some warm mucilagin- 
ous drink. If a spitting of blood from the lungs, should occur 
in consumption, the patient ought immediately to lose blood 
from the arm, in such quantity as the strength of the constitu- 
tion will bear, and have a large blister afterwards applied over 
the chest; he should be kept as quiet as possible, and take cold 
acid drinks; if these means should not stop the bleeding, take 
two grains and a half of fin Imjt made into a pill with bread or 
syrup, and repeat them every two or three hours, until the <£*-<&■ 
bleeding is checked, always taking care after using these pills 
to give some purgative the succeeding day. If the patient re- 
sides in a close situation, in a large town, or contiguous to the 
sea shore, he had better exchange it for one in the country, 
where he can breath a free, pure air, and should daily take as 
much exercise as his strength will admit of when the weather 
is favourable. The best exercise is riding gently on horseback, 
but if the motion excited thereby is found to fatigue, he should 
substitute the use of a carriage. In whatever way exercise is 
taken, the greatest care must be observed to guard against cold 
in any way whatever, either by getting wet or by an exposure 
to night air. Flannel should be worn next to the skin in win- 
ter, and- this be changed for calico during the summer months 
if unpleasant. 



412 

When the patient's circumstances will admit of his remov- 
ing in the early stage of consumption, and before sores are 
formed in his lungs, he should go to a warmer climate; in do- 
ing this, he should most carefully shun all situations exposed 
to the sea, and confine himself, while on shore, entirely remote 
from sea breezes; for it is a singular fact, that, while consump- 
tive persons are benefited by the sea air, when they breathe it 
on the ocean, they are always injured by a mixture of land and 
sea air. It is also a fact, that those situations contiguous to 
bays and rivers, where the salt and fresh waters mix their 
streams together, are more unfavourable to consumptive pa- 
tients, even than the sea shore. Much has been said in favour 
of a residence in the South of France, in cases of pulmonary 
consumption: but late experience has proved that all situa- 
tions contiguous to the shores of the Mediterranean, are un- 
friendly to patients labouring under this disease. In recom- 
mending travelling to consumptive patients, I wish it to be un- 
derstood that this advice applies only to the early stage of this 
disease. On the contrary, when the disease is far advanced, 
the patients should never quit their own country; for, by leav- 
ing it, they will separate from many comforts, and probably 
be deprived of the attention and society of their dearest friends, 
as well as the attendance of professional men, in whom they 
have been accustomed to repose the greatest confidence. 

There is a species of this complaint called Dyspeptic Con- 
sumption. This form of disease is much more common than 
is generally supposed. It is usually preceded by symptoms of 
indigestion, and particularly by those which indicate some dis- 
order in the secretion of bile. Contrary to what is usual in 
other species of the disease, the spirits from the beginning are 
more or less depressed, and the countenance is sallow. [The 
disease the Doctor here describes has its seat in the. liver, un- 
questionably.] 

The cough at first is usually dry, or the patient brings up 
a little mucus, after a severe and often long continued fit of 
coughing, which seems to be rather the effect of the irritation 
of coughing, than any thing which had previously existed in 
the lungs; for the cough, in this species of consumption, par- 



413 

ticularly in the early stage, frequently comes in violent fits. — 
These fits, particularly on lying down, are apt to occur after 
the patient has eaten, especially if much has been taken, or if 
of any thing disturbing digestion. In many cases, they are 
more apt to come on when he lies on the left side. As the dis- 
ease advances, the cough becomes more frequent, returns less 
decidedly by fits, and is attended by a more copious expecto- 
ration. 

Bloody expectoration is by no means uncommon in this spe- 
cies of consumption. Blood often appears early in the disease, 
mixed with colourless phlegm. After the pus-like expectora- 
tion commences, if blood has not previously appeared, it is 
much less apt to appear than in other forms of the disease. 

While the blood is mixed only with a transparent fluid, 
there may be good hopes of recovery, — certainly better than un- 
der the same circumstances in any other species of consump- 
tion. A similar observation applies to the pus-like expectora- 
tion. If there be no admixture of blood, there may be good 
hopes of recovery, if the disease has not lasted long. 

The breathing, in the earlier stages of this species of con- 
sumption, is sometimes more oppressed by the recumbent pos- 
ture, than in other forms of the disease, and is more frequent- 
ly attended by a sense of tightness across the pit of the sto- 
mach. It is very rare, except in the advanced stages, 
that there is much difficulty of breathing on exercise, which so 
frequently attends even the commencement of other species of 
consumption. There is often little or no pain; but in some ca- 
ses, the patient is subject to a dull pain in the pit of the sto- 
mach, or pretty low down in the left side of the chest; more 
rarely the pain is in the same part on the right side. There is 
hardly ever a fixed pain high in the chest, except about the 
shoulders; there, it is not uncommon, and then it is frequently an 
uneasy sensation only, and a sense of oppression under the breast 
bone. 

The patient sometimes complains of darting pains in vari- 
ous parts of the chest, and frequently in more distant parts, 
particularly in the back and shoulders, and in the legs, and is 
often subject to headach. The hectic fever is hardly ever form- 



414 

ed at so early a period as in other species of consumption, and 
the fits are not so regular; besides, the skin is generally dry in 
the morning, and the emaciation is seldom so rapid. 

The patient is often distressed with flatulence, acidity, and 
irregular bowels; the tongue is furred; the appetite, for the 
most part, contrary to what is usual in other forms of the dis- 
ease, much impaired Sometimes there is a false appetite, 
which fails after a few mouthfuls, and a sense of oppression af- 
ter eating, as if there were not room for what had been taken. 

The discharge from the bowels is seldom well coloured, and 
the pit of the stomach is more or less full and tender on pres- 
sure. In addition to these, some other of the more prominent 
consequences of severe affection of the digestive organs, some- 
times show themselves, particularly dropsy of the belly, which 
never supervene in other species of consumption. [The Doc- 
tor furnishes proof here, that the liver is the seat of the dis- 
ease y as before remarked.] 

In treating this species of consumption, our attention should 
first be directed to the diet of the patient, and every thing diffi- 
cult of digestion should be strictly prohibited. The patient 
should eat but little at a time; and frictions should be used 
■with the hand or brush, over the region of the stomach, after 
each meal. Frictions with salt, have also been highly recom^ 
BienderL The best medicine to correct this deranged state of 
the digestive organs, is the blue pill of mercury, given in doses 
of one or two grains, with half the quantity of ipecacuanhae and 
rhubarb, and repeated two or three times a day, in order to 
keep the bowels a little laxative. Some gentle tonic, such as 
infusion of gentian, and quassia, chammomile flowers, or cold 
infusion of wild cherry tree bark, provided the pain or febrile 
symptoms should not forbid it. In fact, the remedies for this 
species of consumption are such as are best calculated to cure 
dyspepsia or indigestion; taking care always to adapt them to 
the state of the patient. — [In, other words, to cure a chronic 
affection of the liver.] 

There is another species of this disease, called Gallofiing 
Consumption, and generally succeeds severe inflammation of the 
mucus membrane of the lungs; and it is astonishing what quan- 



415 

tities of mucus, and sometimes even purulent matter, are se- 
creted in a short time. Unless this excessive secretion. is 
quickly arrested, the patient's strength becomes exhausted: a 
train of fatal symptoms follow, and life is hurried to a close. 

I have had considerable practice in this disease: and recom- 
mend with great confidence, pills composed of sulphate of iron 
(copperas) one grain, rhubarb one grain, gum myrrh two grains, 
oil of cloves one drop. These pills should be repeated three 
or four times a day, and ten or fifteen drops of sulphuric acid 
taken every two or three hours in a cup of mucilage, or barley 
water, when the febrile symptoms are urgent. I have some 
times used with advantage pills composed of sulphate of cop- 
per (blue vitriol) one grain, ipecacuanha one grain, made into 
a pill, and repeated every three hours. 

[I would by no means recommend a reliance solely on Doctor 
Huntt's prescriptions. I can have no doubt but that the deter- 
mination to the lungs ought to be relieved by more powerful 
means. Large blisters ought to be kept discharging from the 
sides. All the extremities should be daily rubbed until sore- 
ness is excited. I would have them at least reddened continu- 
ally by some irritating application: and I know of none better 
than applying a large blister for an hour to part of the body. 
It should not be kept on to blister: but merely to excite a little 
soreness on the skin, which is to be kept up. Perhaps rubbing 
with powdered Spanish flies would answer.] 

In the advanced, or typhus stage of consumption, the patient 
is much distressed, and weakened by excessive sweating dur- 
ing the night. These should be checked and counteracted by 
the following remedies: Fifteen drops of sulphuric acid in two 
or three ounces of a simple infusion of red rose leaves, may be 
taken in the form of a draught, three or four times a day, and 
two or three pills, consisting each of one grain of sulphate of 
iron, (copperas) two grains of myrrh, and half a grain of rhu- 
barb; infusion of wild cherry tree bark, made with cold water; 
tar water, chammomile tea, Fowler's solution of arsenic; the 
Peruvean bark, are all good tonics in this stage of the disease; 



416 

but in administering these medicines, great regard should al- 
ways be paid to their effects, and whenever any unpleasant 
symptom is excited, the medicine should be abandoned and 
some other tonic substituted, and tryed at first during the morn- 
ing remissions of the fever. 

A purging is another troublesome and exhausting affection 
attendant on an advanced stage of consumption, and is very apt 
to alternate with profuse sweating; for as soon as the one is 
stopped, the other too frequently comes on, producing thereby 
an extreme degree of emaciation and debility. Here it will be 
necessary to use opium united with a small portion of ipecac- 
it anhae or sugar of lead, if the complaint is obstinate. An infu- 
sion of galls, or tormentil root with cinnamon and gum arabic, 
are also important remedies in checking the purging. The 
strength of the patient should always be supported by cordial 
drinks, jellies, and nourishing diet — the preparations of arrow 
root, sago and rice, are very proper. About this stage of the 
disease, it is not unusual for the mouth and throat, and indeed 
the whole alimentary canal, to be occupied with little, sores like 
those of the thrush. Astringent gargles, aided by tonic and 
astringent medicines, are the only means of affording any relief 
in these affections; and most generally when these symptoms 
do occur the patient survives but a short time. 



PARTICULAR INFLAMMATIONS, 

ATTENDED 

WITH FEVER. 

These are to be treated in general according to the princi- 
ples detailed in the treatment of general inflammation, in the 
beginning of this address, to which you should refer. It only 
therefore remains for me to state some peculiarities requisite, 
in the treatment of several inflammations. 



417 



INFLAMMATION OF THE BRAIN. 

This is produced by all causes which tend to excite apo- 
plexy, or fulness of the head — and by none more than exposure 
to the rays of a hot sun. Its characteristics are violent fever, 
severe pain in the head, redness of the face and eyes, great in- 
tolerance of light and sound, watchfulness, and delirium. It is 
usually preceded by long continued watching, pains in the neck 
and crown of the head, defect of memory, diminution of urine, 
and irregular pulse. As the disease advances, the eyes sparkle 
greatly, there is ferocity in the countenance, restlessness, deaf- 
ness, rovings, and increased pulsation in the arteries of the neck 
and temples. The tongue is dry and of a yellow or black co- 
lour, the face of a deep red, and the pulse becomes small, quick 
and hard. It is always a most alarming disease, and often ter- 
minates fatally about the third or seventh day. 

The patient is to be bled most profusely: and it ought to be 
done, if practicable, while he is sitting up, and the blood taken 
from a large opening. It is best to bleed from the veins of the 
neck and temporal arteries. Thirty or forty ounces of blood 
taken away suddenly, is found to be more efficacious than dou- 
ble the quantity slowly drawn. Bleeding by cupping- the tem- 
ples, and indeed cupping the whole head, must be tried, espe- 
cially if the general system seems much reduced by the gene- 
ral bleeding. Over the head, in the first instance, cold appli- 
cations of iced water, are to be made and renewed frequently. 
The most powerful purgatives are to be administered: and in- 
jections of ten or fifteen grains of tartar emetic should be giv- 
en daily, so long as the symptoms continue violent. Doses of 
tartar should be given by the mouth, if the injections do not 
pUrge. The patient's head should be kept as elevated as pos- 
sible, to lessen the determination of blood to it: and the same 
effect will be produced by partially scalding the feet, and by 
blistering the arms and legs — but these are only to be applied 
after the violent action is reduced. When the fever subsides, 
and the mind returns to reason, it will be very necessary to ob- 
C c c 



418 

serve the utmost caution respecting all exciting causes: as 
when the inflammation has once been excited, slight causes 
bring it on again. 

The diet and drinks are to be of the mildest kind. Light 
should be excluded, and indeed every thing which can excite 
the system, particularly a hot room and foul air. 

Some have recommended the application of a blister over 
the head; others have found injury from it, and prefer the cold 
applications of vinegar and iced water, and of ether to produce 
cold by evaporation. 

In inflammation of the brain arising from sympathy with 
affections of other parts, the remedies are not to be applied 
with such vigour as when the disease is original: nor should 
they prevent a proper attention to cure the primary affection „ 



VIOLENT INFLAMMATIONS WITHIN THE CHEST^ 

CALLED 

PLEURISY, BASTARD PLEURISY, &c. 

In the treatment of inflammations within the breast, it is not 
very material to determine what particular part is attacked, 
although different names are given when different parts are 
supposed to be the seat of the disease. Generally but one side- 
at a time is inflamed; and pleurisy comes on with an acute pain 
in the part, which is much increased on making a full inspira- 
tion. The face is flushed; the heat of the whole body increas- 
ed; there is difficulty in laying on one side; the cough is short 
and suppressed and dry — but a mucus is occasionally spit up 
from the lungs occasionally thin, but gradually thickening and 
sometimes streaked with blood: the pulse is hard, strong, and 
frequent, and vibrates like a tense string of a musical instru- 
ment: and the blood when drawn exhibits the sizy or buffy coat. 

The causes of pleuretic attacks, are those which produce all 
other inflammations, but they are most frequently produced by 
breathing a warm after that of a cold air — like inflammations 



419 

of the extremities when brought suddenly to the fire after expo- 
sure to cold. The winter and the spring are most common sea- 
sons of attack. 

The termination of the inflammation is in its dispersion, call- 
ed resolution; in the effusion and discharge of blood, or secre- 
tion of mucus; in the formation of matter in a cavity, called ab- 
scess; and occasionally in the mortification of the part inflam- 
ed. It should always, like all attacks of such vital parts, be 
considered very dangerous and requiring most energetic treat- 
ment in the commencement, to avoid sudden death or lingering 
disease. 

Cold, in most inflammations, is an important means of cure: 
but in this it is so much the reverse, that the patient should 
always be kept in a warm, comfortable apartment. Being plac- 
ed 4n such a one, the first step is to bleed profusely. The quan- 
tity drawn should be in proportion to the urgency of the symp- 
toms and constitution of the patient; but if called early, you 
will never err in the beginning if you will set the patient up in 
bed, and take blood from a large orifice until fainting is pro- 
duced, or the pulse sinks. When he is recovered from this 
sinking state, give three or four grains of calomel combined 
with half a grain of tartar emetic, or three grains of antimonial 
or James's powder, and repeat this dose every three hours, 
until a free operation is produced on the stomach and bowels. 
In order to promote perspiration, the patient should drink 
freely of warm barley water, flax seed tea, or some other 
warm mucilaginous drink. If these powders do not operate 
freely on the bowels, they should be followed by a dose of epsom 
or glauber salts, or castor oil and clysters. This disease is fre- 
quently accompanied with strong bilious symptoms: therefore 
in applying our remedies, a due regard should always be paid 
to the symptoms. In every fit of this fever, if there be much 
pain, difficulty of breathing, or a short, suppressed cough; 
bleeding should be repeated, and followed by the powders of 
calomel and tartar emetic, or powders composed of a quarter 
or half a grain of tartar emetic, with ten grains of nitre, mixed 
in a cup of warm barley water, or flaxseed tea, and repeated 
every two or three hours. In making choice of these powders, 



420 

you should always be governed by the state of the bowels. 
After this bleeding and purging, very large blisters may always 
be applied with advantage to the side or breast, and repeated, 
from time to time, until all pain, or uneasiness is removed. 
When the inflammatory symptoms have greatly subsided, we 
may depend chiefly on sweating medicines, with warm mucil- 
aginous drinks, taking care that the bowels are kept in a laxa- 
tive state. When the disease shows a disposition to pass off, 
by expectoration, we should endeavour to encourage this ten- 
dency, by giving a tea, made of one ounce of pleurisy root, 
or by giving a decoction of Seneka snake root with gum arabic, 
and some antimonial medicine. During the whole course of 
this disease, the patient should abstain from all solid food, as 
well as every other article of diet, which may be calculated to 
excite the system in the slightest degree, his drinks should al- 
ways be warm, mild and mucilaginous. These with frequent 
inhaling of the vapour of warm water and milk, will promote 
expectoration.-— [Z)r. Huntt?^ 



INFLAMMATION OF THE HEART. 

This disease is accompanied with fever, pain in the region 
of the heart, anxiety, difficulty of breathing, cough, unequal 
pulse, and sometimes fainting. 

Inflammation of the heart, arises generally from the same 
causes, that produce other pleurisy, and particularly from an 
irregular exposure to cold. Sometimes it is occasioned by a 
sudden translation of gouty or rheumatick action to the heart. 

In the acute stage of this disease, great energy and prompts 
tude are required in the application of the remedies. Blood 
should be taken from a large orifice, and the quantity drawn, 
should be as free as the age and constitution of the patient 
will permit: indeed, a successful practice in this disease, de- 
pends chiefly, on prompt and copious abstractions of blood: 
extensive blisters, purging, and sweating, by frequent doses of 
calomel and tartar, are powerful auxiliaries. Tincture of fox- 
glove, in doses of twenty or thirty drops, repeated every three 



421 

or four hours, will tend to reduce the violent action of the 
heart, and it should be tried. Rest, and spare diet, should 
also be particularly enforced. 

When this disease arises from gout or rheumatism, the same 
remedies are proper, but not to such an extent, It may be ex- 
pedient in such cases, to give medicine to act on the stomach, 
as the spirit of camphor or tincture of meadow saffron: espe- 
cially, if the constitution of the patient is enfeebled, which is 
often the case — \_Br. Huntt."] 



INFLAMMATION OF THE STOMACH. 

This disease is distinguished from all others, by the violent 
burning, pain, heat, distension, and soreness in the region of 
the stomach; by the increase of pain when any thing is swal- 
lowed, and its immediate rejection; and by the sudden and 
greater depression of strength in this, than in any other disor- 
der. It is accompanied with distressing thirst, anxiety, and 
continual tossing of the body. 

It is excited by any acrid, corrosive matter taken into the 
stomach; by improper food, and over-drinking, especially when 
the body is heated; by external violence from wounds and blows, 
and by the translation of morbid actions from other parts, as 
in the gout. 

This disease is rare, and of doubtful termination. The cure 
is to be attempted by large bleedings in the beginning — not to 
be prevented by the smallness of the pulse, the debility or the 
convulsions which may ensue. The evacuation ought to be re- 
peated three or four times a day, until the inflammation sub- 
sides; and with no less energy should you cup the whole bel- 
ly, and apply a large blister on it. An injection of three grains 
of tartar emetic may be tried, to determine to the skin; also, va- 
pour bath. The only drinks which should be taken are those 
of the mild, mucilaginous kind, or sweet oil, which tends to al- 
lay inflammation. I have no authority for it; but I would ven- 
ture to administer occasionally a weak solution of sugar of 



lead, to subdue the inflammation; as I see no reason why It 
should not do in the stomach what it does elsewhere. 



INFLAMMATION OF THE INTESTINES. 

Pungent pain in the belly, spreading and acute around the 
navel, sickness and vomiting, costiveness and fever, mark this 
disease. It is attended with all the ordinary symptoms of fe- 
ver, thirst, &c; the pulse is quick, hard and small. After a 
short time, the pain becomes more severe; the whole region 
over the belly is highly painful to the touch; great costiveness 
prevails, and the urine is voided with great difficulty and pain. 

The disease is excited by causes similar to those producing 
inflammation of the stomach, and it is attended with danger 
nearly as great. The cure is to be conducted on the same prin- 
ciples. After the repeated sudden drawing of blood from the 
arm through a large orifice, cupping on the back and belly, or 
applying leeches to the belly, and a large blister over it; we 
may apply cloths from hot water to it; and, if the stomach will 
bear it, administer a purgative of castor oil or calomel. The 
mildest mucilaginous drinks only should be taken throughout 
the complaint. 

Such are the ordinary directions for treating this disease. I 
would try doses of sweet oil, and sugar of lead, as with the sto- 
mach; also, injections of cold lead water, which, on very ra- 
tional principles, would surely tend to reduce the high action. 

This disease is very apt to recur in the same person after it 
has been cured. This requires, therefore, that the person who 
has fortunately escaped its attack, should be cautious about his 
diet, selecting the most simple articles, and those known best 
to agree with his constitution. He should always have his 
skin well rubbed, and wear flannel next to it. 

INFLAMMATION OF THE LIVER. 

The characteristics of this are fever; distension of the right 
side, a little under and below the ribs; sometimes severe pain, 



423 

as in pleurisy, increased on pressing the part; sometimes dull 
pain about the collar bone and right shoulder; uneasy lying on. 
the left side; difficult breathing; dry cough; vomiting of bilious 
matter; and frequently some degree of jaundice. 

Of this disease there are two kinds: the one acute, shewing 
all the symptoms of violent inflammation; the other chronic, of 
a less active nature, but with an enlargement and hardness of 
the liver, with a blunt kind of pain. 

The acute species of the inflammation of the liver, comes on 
with a sense of chilliness and pain in the right side, sometimes 
dull, sometimes sharp, and extending, &c. as above described. 
The intestines are generally inactive, and the stools show a de- 
ficiency of bile; the urine is of a deep saffron colour, and small 
in quantity; there is a loss of appetite; great thirst, with a 
strong, hard, and frequent pulse, beating from ninety to one 
hundred in a minute, and sometimes intermitting; the skin is 
hot and dry, and the tongue covered with a white and some- 
times yellowish fur; and when the disease has continued for 
some days, the skin and eyes become tinged with a deep yellow, 
particularly if the disease be in consequence of bilious stones 
in the canals, carrying the bile to the bowels. The appearance 
of the blood is somewhat remarkable just before it coagulates, 
when the red part falling to the bottom, and the buffy coat not 
being formed, it appears of a dull green colour: and when the 
coat is formed, it is not green, but yellow. There is in this, as 
in all other diseases — the description of which can only be ge- 
neral — very considerable variations. The acute inflammation 
is said to be chiefly of the membrane covering the liver; the 
chronic, the substance of that organ. 

The chronic species is usually accompanied with a morbid 
complexion, decay of appetite, despondency of mind, headach 
or giddiness, general weakness, a morbid sensibility of the ner- 
vous system, costiveness, indigestion, flatulency, acidity, pains 
in the stomach, yellow tinge of the skin and eyes, clay-coloured 
stools, high coloured urine, depositing a red sediment and ropy 
mucus, an obtuse pain in the region of the liver extending to 
the shoulder, together with a sense of weight, unusual fulness, 
some enlargement and hardness of the liver, not unfrequently 



with a slight difficulty of breathing. These symptoms are, 
however, often so mild and insignificant as to pass almost un- 
noticed until the disease has affected the bowels and skin. 

The disease is produced b- all causes, so often enumerated, 
which excite inflammation: but the chronic more especially by 
the use of spirituous liquors, by residence in hot climates, and 
by intermittent fevers long continued. The outlet of the lives 
of most of the intemperate can fairly be traced to the liver; and 
I have seldom known a man who had resided long in the East 
or West Indies, who did not early on his return to this country, 
fall a victim to the derangement of this organ. It is said that 
the climate of those countries causes the diseases to locate 
themselves as frequently in the liver, as that of England does 
on the lungs. Our own country partakes of the two, probably, 
in equal proportion. 

The termination of this inflammation is like that of others: 
but most commonly in the formation of matter in an abscess, 
which has to be discharged; or in its schirosity, producing 
dropsy of the belly and disorder in all its contents. 

During the active stage of this complaint, the only chance of 
preventing the formation of matter is to bleed freely again and 
again, and so long as the symptoms shall be violent; and the 
remedy equally wanted, is powerful and constant purging until 
the same effect is produced. Calomel and jalap may be chang- 
ed for other purgatives occasionally. Cupping freely and dai- 
ly over the liver, will also tend to draw off the blood from the 
interior. A large blister over the liver, will also prove highly 
beneficial on the same principle. And small doses of tartar, as 
in other fevers of this grade, will be prober. The diet is to be 
the mildest vegetable matter; the drinks, any weakly acidulat- 
ed water. The air to be cool and pure, and rest strictly enjoin- 
ed. The warm bath, rubbing the skin whilst in it, is also 
to be tried. 

If the energetic means recommended, be not crowned with 
success, as if they were not early applied, it is proper to at- 
tempt to excite salivation. Mercury has been emphatically 
called the key to the liver, so powerful is it in the correction of 
its disorders. It is adviseable to begin as soon as the first or 



480 

must active stage is over ©r reduced, and generally it may be 
commenced about the fifth day of the disease. I have no au- 
thority for it; yet I would, at least to my own patient, first pre 
scribe the temporary salivation, by taking a grain and a half of 
corrosive sublimate at bed time, which, while it evacuated the 
mouth, might tend to relieve the liver. 

The plan ordinarily pursued is about a drachm of the mer- 
curial ointment over the region of the liver, every night until 
some slight salivation is produced, or rather until some very 
obvious effect is produced on the constitution. The friction 
over the liver is supposed to aid in dispersing its enlargements 
But if it should give pain, the mercury may be rubbed on the 
interior of the thighs and arms. 

Should it be adviseable to hasten the mercurial action, calo* 
mel may be given two or three times a day, in doses of one or 
two grains, at least enough to keep the bowels well opened.— 
The blue pill of the shops, may be substituted for calomel, if it- 
operates too much on the bowels; or a little opium occasional-* 
ly, with antimony, if the fever be considerable, may be given. 

When matter, or a cavity called abscess, is formed in the 
liver, the patient's strength will lessen; and Dr. Thomas advi- 
ses the administration of bark and nitre, with nutritious and 
moderately stimulating diet. To favour the discharge of the 
matter externally, a large soft poultice should be kept con- 
stantly applied to the part affected. When the tumour points 
outwards, and there is reason to believe matter is formed, it is 
to be opened and the cure conducted by a surgeon. 

The cure in chronic inflammation of the liver, is effected by 
mercury. It is to be given in small doses, and slowly, so as to 
keep up the mercurial taste in the mouth for a considerable 
time, without producing much flow of spittle; (see salivation) 
as in this way it promotes the secretion of bile and gives action 
to all the small vessels. 

During the cure, the bowels are to be kept in regular daily 
.motion. The skin should be kept in as natural a state as pos- 
sible. It should be gently rubbed every night, particularly over 
the liver, and flannel should be worn next it. The warm bath 
will be proper, if used with such caution as to prevent getting 
Dd d 



430 

cold. When there is much pain about the Uver, blisters may 
be frequently applied over it, and cupping without scarifica- 
tions can never do harm; and I believe the more frequently it 
is used — within reasonable bounds of course — the better. Dr. 
Thomas recommends a large plaster of gum ammoniac to 
be spread over the whole diseased surface, which acts medi- 
cally, and on the principle of a bandage giving support. Why- 
would not a well-applied bandage, or broad belt, be of service, 
as in other enlarged parts, by producing compression? 

The nitric acid, diluted ih water and sweetened so as to be 
palatable, has been very highly^ commended for its effects in 
relieving the liver. Indeed some prefer it to mercury. I have 
had considerable experience of its efficacy, and do certainly 
prefer it in general: as it acts as a tonic, and certainly when it 
fails to relieve the local disease, leaves the system in a better 
state to encounter the operation of mercury. A quart bottle of 
water made agreeably sour with it, is to be drank throughout 
■the day, as when recommended to relieve the system from the 
effects of mercury. 

Lately the dandelion has been recommended in these cases 
by Dr. Pemberton, of which I know nothing. Travelling, I 
am sure, would prove serviceable in such affections, as well as 
in consumption. 



INFLAMMATION OF THE SPLEEN. 

This organ is situated in the left side and is susceptible of 
considerable enlargement: when enlarged it forms the ague- 
cake, noted among those long having the ague and fever. 
When inflamed, it is attended by the usual symptoms of 
fever: with pain in the left side, extending through the region 
of the belly and into the left shoulder. The pains are increas- 
ed on pressure, and a pulsation or throbbing may be perceived. 
The pulse on the left side is sometimes partially suppressed, 
and often intermittent, weak, and not quick. There is lassi- 
tude, loss of strength, watchfulness, sometimes delirium, vomit- 
ing of green bilious matter: a swelling in the region affected.. 



487 

representing the form of the spleen: faintings: bleeding at the 
nose: but the most remarkable symptom which attends is the 
bloody vomiting— by some considered as peculiar, and called 
by the ancients atra bills. 

The disease is brought on by the ordinary exciting causes of 
fever: and those are most subject to it, who have had long con- 
tinued intermittents as well as indurations of the liver. 

The treatment, as in all such aifections, is to reduce the too 
high action of the system by general evacuations. Local bleed- 
ing opposite, is pi*oper, and also the application of large blis- 
ters. A mercurial course is recommended where the enlarge- 
ment is of the chronic kind: also, one of nitric acid. Dr. Chs, 
Griffith recommends a trial. 



INFLAMMATION OF THE KIDNEYS. 

Of this there are two kinds, one arising from stones in the 
kidneys, to be considered under the head of gravel: the other 
from an inflammation of the outer coat of the kidneys. 

This species of inflammation is distinguished from colic, by 
the pain being seated very far back: the urine being of a deep 
red colour, voided frequently and in small quantities; it may be 
known from rheumatism of the loins (lumbago), as there is no 
increase of pain on motion. 

It may be distinguished from gravel in the kidneys, or stones 
coming from them, by the symptoms of fever accompanying 
or immediately following the attack of pain, and these continu- 
ing without any remarkable intermission; whereas when gravel 
is in the kidneys, one pain does not succeed another for a con- 
siderable time: in gravel, too, a numbness of the thigh and re- 
traction of the testicle on the affected side, usually take place, 
with constant sickness at stomach and vomiting. 

The causes of this inflammation are external blows, strains 
of the back, violent and severe exercise in riding or walking, 
exposure to cold, or stone in the kidneys. The gouty are very 
subject to this complaint: and so are those of full habits, much 
given to drinking too much spirit. 



*8& 

It is attended with a sharp pain on the affected side, extend- 
ing along the canal to the bladder, called ureta. There is fre- 
quent desire to make water, with much difficulty in doing it; 
the body is costive, the skin dry and hot; the patient feels great 
uneasiness in endeavouring to walk, or set upright: he lies with 
most ease on the affected side, and is incommoded with sick- 
ness or vomiting. 

The remedies are general blood-letting, to be carried as far 
as circumstances admit, and so to be repeated. Free cupping 
over the small of the. back, is an important auxiliary. Then 
flannel cloths wrung out of hot water, or bladders with hot wa- 
ter, are to be applied to the small of the back, and a clyster 
given of hot water. The drinks should be warm, of any of the 
mild mucilaginous articles. 

The bowels are to be kept open by doses of castor oil, calo- 
mel, or cream of tartar, as well as by clysters; and the patient 
may frequently be put in the warm bath, where his skin may 
be rubbed to increase the determination to it. Small doses of 
tartar emetic may be given at repeated intervals: and I would 
recommend injections of eight or ten grains twice a day, to mo- 
derate arterial action and determine to the fundament. 

After the violence of the inflammation is reduced, to allay 
pain, opium may be taken and laudanum injected up the 
bowels. 

A decoction of dried leaves of the peach tree, prepared and 
drank as for vomiting of blood, has been recommended in this 
disease. 

- When matter has been formed, and it is deposited from the 
urine on its standing, if the fever do not forbid, tonics and sti- 
mulants become proper. The uva ursi, in these cases, is es- 
teemed by Dr. Thomas the best medicine. 

INFLAMMATION OF THE BLADDER. 

Tension and pain over the bones in front, a little above 
the penis, with a frequent desire to make water, difficulty in 
voiding it or total suppression, with constant inclination to 
stool, and general fever, are the symptoms of this disease^ 



4&9 

It is mostly caused by too long retention of urine; a stone in 
the bladder; or may be produced by all the general causes ex- 
citing inflammation on sensible parts. 

The remedy is to evacuate the patient by the lancet: to give 
small doses of tartar emetic and calomel: and to keep the pa- 
tient in the warm bath. Cupping over the part will prove ser- 
viceable; and injections of warm water ought frequently to be 
made into the bladder. This removes the irritating urine, and 
tends to saoth the parts. After this washing is finished, I cer- 
tainly would inject occasionally a very weak solution of cool 
lead water, to lessen the inflammation: at least, I have never 
heard of any thing better calculated for this object. 

Blisters are improper; as they act particularly on the blad- 
der, as frequently demonstrated in the suppression of urine by 
a blister plaster. But I see no reason why counter action on 
the surface may not be produced by other irritants: as a strong 
solution of corrosive sublimate, nitric acid, or any other arti- 
cle of the kind. 



DIFFICULTY IN MAKING URINE— STRANGUARY. 

Difficulty in making urine may arise from several causes; 
particularly the inflammation of the bladder, last treated of; an 
obstruction in the channel leading from it, called urethra, formed 
by a stricture or contraction, which is only to be relieved by 
surgical aid; and by the influence of Spanish flies on the system, 
whether applied externally or taken internally, producing what 
is called a stranguary. 

This is to be relieved in men as in women, by large draughts 
of mucilaginous liquors; and if not, by an injection of starch 
and fifty or sixty drops of laudanum; thirty drops of the tinc- 
ture of tobacco, given twice or thrice a day, has sometimes af- 
forded relief. 



<£30 



SUPPRESSION OF URINE. 

This may be brought on by inflammation of the urethra, ob- 
$tructing the passage of urine, or by a spasm at the neck of the 
bladder. It is to be considered as a very dangerous disease: 
requiring very prompt and powerful means to prevent the over 
distension of the bladder, which must terminate fatally. 

To obviate inflammation, very free bleeding and purging are 
necessary, and to an extent equal to the strength of the consti- 
tution; and cloths from hot water, applied to the pubes, will 
lessen the irritation. The same treatment answers for a spas- 
modic affection of the urethra, or neck of the bladder, imped- 
ing the passage of the urine. The bleeding should be so sud- 
denly done, as to produce fainting, during which there is a ge- 
neral relaxation of all the muscles. This state is most effectu- 
ally produced by keeping the patient in the warm bath for a 
length of time. The injection of sweet oil, or milk and water, 
up the urethra, has in some instances produced relief. Dr. 
Thomas recommends the exhibition of opium, not only by the 
mouth, but by injection with mild mucilaginous liquids to over- 
come the spasm. Throwing cold water on the belly and thighs 
has sometimes enabled persons to void their urine when other 
means failed. 

All these means failing, we are then to try an injection of 
tobacco, made by between half and one drachm of tobacco 
infused a few minutes in boiling water. This is well ascer- 
tained to be the most effectual means of producing universal 
relaxation; for it speedily makes the patient become faint and 
sick, the pulse sinks, profuse perspiration ensues, and general- 
ly very soon the urine flows. The effects of tobacco in this 
way, are sometimes very dangerous; so that great caution is 
necessary, at least in its repetition. 

Sometimes an injection of the decoction of tobacco up the 
urethra, has produced the relaxation of the parts. I would 
greatly prefer the decoction of the Jamestown weed, as it cer- 
tainly produces a more speedy relaxation. 



431 

The muriated tincture of iron, is a remedy which has suc- 
ceeded, when tobacco has failed. It has been given in doses 
of ten drops, every ten minutes, until some sensible effect was 
obtained. Six doses are said to be sufficient to effect the eva- 
cuation. 

These remedies failing, the only chances of saving the life 
of the patient, rest in the capacity of the surgeon to introduce 
a catheter into the bladder; or failing in that, to puncture the 
bladder, for which it is presumable he will be qualified with- 
out my quoting an account of the manner and place of oper- 
ating. 



INABILITY TO RETAIN THE URINE. 

This is a most unpleasant affection, rendering the patient 
very disagreeable; and it arises from a palsy of the muscle, 
which by its contraction in health retains the urine in the 
bladder, until the desire for evacuating it. The cause is gene- 
rally excessive venery or use of spirituou's liquors. 

Mr. Charles Bell, a very distinguished surgeon of London^ 
states that the reason children pass their urine in bed, is their 
sleeping on their backs instead of on their sides, as the occur- 
rence only takes place when the child is in that position. The 
cure is therefore simple, consisting only in making the child 
sleep on the side or belly. He adds, that when a child wets 
the bed, it arises from a dream, excited by irritation of the 
sensible spot, a little behind and below the orifice of the blad- 
der, by the urine resting there and stretching the bladder. 

When an incontenance of urine prevails in consequence of 
weakness or relaxation of the parts: the cure is to be attempt- 
ed by the general cold bath; but more particularly, by pouring 
cold water about and around the privates, every morning and 
night. Blisters between the fundament and privates, are pro-* 
per; also tonic medicines. The Uva ursi is advised, in doses, 
twenty or thirty grains, twice a day, with about half a pint of 
Time water after each close. Electricity has done good. Vs- 



$32 

ternal pressure by means of a suitable bandage lb a line with 
the urethra, has been recommended as very serviceable. 

When the disease cannot be cured, the men can wear some 
vessel adapted to the penis to receive the urine as it drops; 
and women can have a sponge so fastened as to answer the 
same purpose. 



SWEET AND EXCESSIVE URINATION. 

This disease is called diabetes; or I would call it a consump- 
tion in the kidneys, and in conformity to Dr. Rush's doctrines 
of that complaint, a constitutional affection: of which indeed, 
there can be no doubt, from the general symptoms. These 
are uneasiness and disinclination to motion, dryness and harsh- 
ness of the skin, costiveness, great thirst, accompanied by 
a defect in the conversion of food into chyle and blood; gra- 
dual emaciation of the whole body, and a frequent discharge of 
urine, containing a large portion of sugar and other foreign 
matter, which is generally voided in quantities far exceeding 
the food and drinks taken by the patient. 

The causes are too free use of dieuretic medicines, intem- 
perance in life, hard drinking, excess in venery, profuse evacu- 
ations, immoderate use of acid drinks, excessive labour, joined 
to a poor diet, depressing passions, or by any thing tending to 
produce general debility. 

As in consumption, the secretory vessels have their state and 
actions changed, so in diabetes, the action and state of the 
vessels of the kidneys are modified in a different manner from 
natural: and of course when the blood is carried to them, it 
assumes different forms; and hence, different compounds are 
the result. On dissection, the morbid or diseased state in 
which these organs are formed, proves that their derangement 
is the cause of the deranged secretions. 

It is contended by some, that the primary seat of the disease 
is in the stomach, proceeding from some morbid change in 
the natural powers of digestion, and conversion of food into 
chyle for supplies of blood. That tha kidneys and other parts 



433 

of the system, as the head and skin, are affected secondarily, 
and by sympathy. That the affection of the stomach consists 
in an increased secretion of its juices as well as their corrup- 
tion, and the cure is to be affected through this organ. 

This disease comes on sometimes slowly, without any previ- 
ous disorder: and now and then it rises to a considerable de- 
gree, and continues long, without being accompanied with evi- 
dent disorder in any particular part of the system: the great 
thirst and voracious appetite which frequently occur in it, be- 
ing often the only remarkable symptoms. Sometimes the dis- 
ease is preceded by great disorder of the stomach — soon fol- 
lowed by extreme dryness of the skin, with a sense of weight 
in the kidneys and pain in the urinary passages: and there is an 
evident decline of all the natural functions of the body and en- 
ergy of the mind; — the lungs become affected; there is great 
emaciation; pulse very variable; the feet become dropsical; an 
obscure fever prevails; and so on, till death terminates the de- 
rangement. 

The urine, from being at first insipid, clear, and colourless; 
soon acquires a sweetish or sacharine taste: this being the lead- 
ing characteristic of the disease in many cases. 

The treatment of this disease, is conducted upon the princi- 
ple of diverting the increased discharge to other parts, and af- 
terwards of restoring the tone of the system, particularly of the 
kidneys. For the first object, emetics have been prescribed: 
and medicines to excite a determination to the skin; as tartar 
emetic, with opium and Dover's powders; the warm bath; flan- 
nel on the skin, with general and hard rubbing all over the bo- 
dy. Blisters have been recommended, to be applied on the 
small of the back and kept discharging for some time. 

For the acidity of the stomach, lime water, chalk, or soda, 
may be occasionally taken: and tonic medicines— as iron, the 
astringent barks, &c. 

The patient is to refrain from all strong drink: to eat no ve- 
getables, living altogether on animal food; and take the utmost 
care to avoid cold exposures. I would advise not only the 
most hard and constant friction on the skin, but dry cupping 
from head to foot occasionally. Surely it is the most certain 
E e c 



434 

mode of determining the action to the surface, so as to relieve 
that within and not weaken the patient. The feet should fre- 
quently be scalded as for whitlow; that is, dipped suddenly in 
and out of as hot water as can be borne. 

On the other hand, in later times, some very important cures 
have been effected by frequent bleeding, and under circumstan- 
ces of great prostration of strength. The bleedings should be 
small in the beginning: and, as repeated, increased in quantity. 
It ought not to prevent exciting irritation on the surface of the 
body, by frictions and cupping. - 



OF DROPSIES. 

Dr. Rush very judiciously remarks upon this subject, that il 
is surprising it so long escaped observation, that too much ac- 
tion in the blood vessels was as frequently the cause of dropsies, 
as too little He considers it, as he does consumption, a dis- 
ease of the whole system, and arising from general debility. 

There are three states of dropsy, most frequently occurring: 
The first is of the chest, in which art can seldom render ser- 
vice; the second is of the belly; and the third of the whole sys- 
tem. Deficient evacuations in fevers, and obstruction in the 
glands of the body, are the immediate causes of the disease. 

The remedies depend on the state of the system, which is 
much more frequently inflammatory than was formerly suppos- 
ed. Indeed, from whatever cause dropsy arises, — from relaxa- 
tion or over action— the compression the effusion of water pro- 
duces, as well as the stimulus applied to parts unaccustomed to 
it, must tend to produce an increased and over action. 

The existence of general dropsy is ascertained by compress- 
ing a part with the point of the finger, which will leave a de- 
pression that will soon be filled up. The existence of drop- 
sy in the belly is to be ascertained by hearing its fluctuations 
on shaking the body, or by patting one side of the belly when 
the hand is on the other side. 

The most important remedy is bleeding, for which much is 
due to Dr. Rush. It should be renewed as often as high action 



435 

can be discovered in the pulse, and also when it is depressed, 
but raises on small bleedings. 

Purging with large doses of jalap, calomel, gambage, and 
salts; vomiting with squills or tartar emetic; neutral salts, or 
two ounces of nitre in a quart of wziter, taken in a wine glass 
thrice a day, and an ounce of cream of tartar in half a gallon 
of water, drank in the day on an empty stomach; all medicines 
operating to increase the flow of urine, called diuretics, are used 
with advantage; the preference being given by many 1o the 
tincture of fox-glove. Sometimes hard labour, low diet, fast- 
ing, fear, making punctures to let out the water, and laying 
down, have effected cures in dropsies of high action. 

Dropsies arising from the low, nervous state of the system, 
are relieved by stimulants, and most by those determining to 
the kidneys. Bitters and aromatic substances infused in wine, 
spirit or beer; acrid vegetables, as scurry grass, horse radish, 
mustard, water cresses; opium, metalic tonics, the alkalies, 
squills, generous diet, copious draughts of cider and water, 
pres;ure from bandages, frictions by means of an oiled or dry 
hand, hot bathing, the cold bath, exercise, punctures in the 
body, have severally cured dropsies of low action. 

It is impossible to give any positive directions for treating 
particular cases of this disease. I have only to recommend 
the ascertaining what is the state of the patient, and try the 
remedies for each state in moderation, and occasionally vary 
them, until you find one that will succeed. A mercurial course 
is always called for when the liver is diseased. 

DROPSY OF THE BRAIN, COMMONLY CALLED WATER IN 

THE HEAD. 

This is a disease almost peculiar to children; and it would 
have been classed in this work among their complaints, but 
from an accidental omission: although Dr. Thomas has arrang- 
ed it among the diseases of adults. 

It is brought on by exposure to the sun, and all causes 
which excite inflammation in the brain, or irritation in the 
bowels. It comes on in a very insidious manner, resembling 



436 

somewhat the approach of the very common fevers of chil- 
ren, and therefore requires great attention to discover its 
first symptoms; and it is the more important that this should 
be done, as when the disease is completely formed, the cure 
is very doubtful, although, in the commencement, it is quite 
otherwise. 

In the first stage, it is an inflammation of the brain, with no 
peculiarities in appearance; but ends in the effusion of a wate- 
ry fluid within the skull, and is often attended by a general and 
great enlargement of the whole head. One of the earliest symp- 
toms of this complaint, is the child's being uneasy on raising 
its head from the pillow, and wishing to lie down immediately. 
Its first stage is marked by the symptoms of fever, such as sense 
of lassitude; aversion to motion; loss of appetite; hot, dry skin; 
flushing of the face; headach, particularly across the brow; 
throbbing of the temporal arteries; quickened pulse; aversion 
to light and sounds; interrupted sleep; starts and screams; 
sickness of stomach and vomiting; costiveness, and occasional 
convulsions. 

The direct cause of the enlargement of the bones of the head 
is not known; but it occurs most frequently in rickety chil- 
dren: and it is ascertained lately, on the best authority, that 
a regular and equal compression on and around the whole skull, 
by a well applied bandage, prevents the enlargement, and often 
expedites the cure. 

In the first stages, evacuations are to be made, to the extent 
that can be borne, by bleeding, particularly from the veins of the 
neck and arteries of the temples, and by scarifying and cupping 
the head and back along its hone, downwards. Cold applica- 
tions should be made to the head, and kept on it. Large purges 
of calomel and jalap should be given, and repeated as long as 
symptoms of inflammation appear. Small doses of tartar emet- 
ic should also be given and repeated in like manner, and blis- 
ters kept discharging on the extremities. Injections may be 
made of tartar emetic, of four or five grains, to aid in diverting 
action from the brain; and it is recommended to irritate the 
nose to discharges by snuffing the powder of fox-glove, or 
snuff, with powdered Spanish flies. 



437 

When the disease subsides, every means are to be pursued to 
support the child's strength, by diet, tonics, and exercise, suita- 
ble to its age and degree of reduction, as is done in the recover- 
ing state from all fevers. 



MADNESS, OR DERANGEMENT OF THE MIND. 

Derangement of the mind, is sometimes hereditary in fami- 
lies, but more frequently it is the result of disease brought on 
by irregularities in the passions, by intemperance, and by sym- 
pathy of the brain with the diseases of other parts, especially 
with the stomach and womb. 

In cases where it is hereditary in families, the chances of re- 
lief are so inconsiderable, that marriage ought to be prohibit- 
ed to such persons, on account of themselves as well as their 
unhappy offspring. 

In cases arising from other causes they can be relieved, most 
generally, by proper care and attention. And first, I have to 
remark, that the primary object you should have in view with 
such deranged persons, should be to confine them in places 
where they can do themselves and others no harm. The 
shameful neglect of this precaution, is annually followed by the 
commission of suicide, and the murder of some unsuspecting 
person, throughout the country. A decent respect of friends 
for the sufferer, and common humanity for others, should lead 
to effectual and instant measures to prevent a repetition of such 
scenes. The apparent meekness of the deranged, forms no ex- 
cuse; for the changes to which they are liable, are too sudden 
to be guarded against. 

The varieties of this disease, are almost as great as there are 
subjects of it, and all attempts to arrange them under particu- 
lar classes, I consider as unnecessary, as they are erroneous. — 
The disease consists in a disordered action in the brain: and 
our remedies are for that, instead of the disordered intellect. — 
A restoration of the one, is followed by that of the other. 

In order to prevent the violent action of the vessels of the 
brain from going to such an extent as to produce disorganiza- 



438 

tion, the most free bleeding is necessary from the veins of the 
neck, called the jugular veins, and from the temporal arteries. 
Shaving, cupping, and applying cloths wet with cold lead wa- 
ter on the head, are equally necessary during the violent stage. 

Free purging with the largest doses of calomel, gamboge, 
jalap, or of any other strong purgative, should be given: and 
also small doses of tartar emetic, to keep up a constant sick- 
ness at. stomach, and thereby lessen the general febrile action. 

When the violence of the disease is lessened, the leading ob- 
ject is to excite action in other parts, to divert it from the 
brain. For this purpose, blisters back of the neck, and on the 
extremities, should be made to a considerable extent. In seve- 
ral instances, I applied blisters to the fundament, and blistering 
Gintment to the very edges; which produced counter irritation 
that speedily relieved the brain; and at the same time injected" 
fifteen grains of tartar emetic in a pint of water into the bow- 
els. This means of relieving the head, I have thought would 
prove of great service. The mild warm bath, long continued, 
has a powerful tendency to allay irritation, and it should be 
tried to a great extent; at least, hot vapour or wet blankets can 
be readily continued on the patient. 

When the disease arises from the stomach, vomits are found 
of great efficacy, as also large draughts of mucilaginous liquids. 
The blisters should be over the stomach, and the extremities be 
freely cupped. The diseases of the stomach, particularly of a 
chronic nature, I have elsewhere stated my belief, generally 
owe their origin to the liver: and that for its relief a mercurial 
course > or one of nitric acid, are chiefly to be relied on, with 
free and repeated cupping of the right side, and frictions on the 
skin. 

When the disease arises from sympathy with the womb, its 
functions should be restored if they are deranged. An irritat- 
ing injection of diluted tincture of Spanish flies, I would try. 
It is a new application in such cases, and its value not known. 
All the means mentioned under the head of suppressed menses, 
to which I refer you, are to be employed: and the excitement 
of the breasts to give milk, or to blister them, I know to be of 



489 

great efficacy in relieving the womb, and thereby it must relieve 
the brain. 

The disease is sometimes periodical: and is to be relieved by 
revolutionizing the system, as mentioned under the head of epi- 
leptic fits, or ague and fever. 

I have repeatedly stated that undisturbed rest is one of the 
most important means of allaying disordered action. In no 
case is it more important than in affections of the brain. If 
the patient will not remain quiet in a dark room, a straight 
waistcoat, as it is called, should be put on. To make one of 
these, nothing more is necessary than a piece of strong canvass 
to extend from the neck to the knees. It is to have sleeves in 
the inside, and to be laced behind. A good substitute, is strong 
linen wrapped around the body two or three times. Rest is ne- 
cessary for the mind as well as body: therefore, silence and gen- 
tleness are necessary in all attendants. 

In the disease called low vapours, or vulgarly termed hifified, 
the foundation is invariably, I believe, in the liver, acting on 
the stomach. The sensation in the stomach, is of a most hor- 
rid kind — analogous to what follows intoxication. Instead of 
the ridicule so foolishly and frequently given to these sufferers, 
they should be salivated: take emetics, and then cordial stimu- 
lating drinks: They should have thei^; skin well rubbed with 
coarse brushes: should travel as long journeys as are required 
for consumptive patients. They should have cheerful, not bois- 
terously merry, company; for high excitements of mirth are 
followed by equal depression — and in none more than those la- 
bouring under this bodily infirmity. 

Will it be necessary to remind you again, that when the sys- 
tem is reduced, when it is in a low state, depletion is improper? 
True, the bowels should be constantly kept open, and all other 
natural operations be promoted. But the diet should be nutri- 
tious and moderately stimulating. To produce irritation on 
the surface of the body, is the chief object in the medical treat- 
ment in such cases: and it should be done without p.oducing 
evacuations; or, in other words, to irritate the skin without pro- 
ducing discharges, 



140 

In violent madness, the tincture of fox-glove has sometimes 
been found of service. I would recommend a trial of the sali- 
vation produced by corrosive sublimate, one and a half g* ains 
in a glass of spirit for several nights in succession. Upon the 
same principle, I would irritate the nose by causing the patient 
to snuff up Spanish flies, or powdered fox-glove; or I would try 
an occasional scarification in the parts most easily touched 
and irritated. 

Notwithstanding that I have said it is a disease of the body 
and the vessels of the brain, we are not to forget that we can 
sometimes powerfully operate on the body through the mind. 
Hence new scenes sometimes produce a change. Regular bo- 
dily labour has sometimes had the same effect. In some in- 
stances, moderate punishment may be permitted — but given 
only by the sensible, not the passionate— the friend, free from 
anger, instead of the turbulent keeper. In short, the patient's 
particular prejudices should be consulted so far as they are not 
prejudicial; and on symptoms of recovery, there should be a 
gradual restoration to original habits, and those original cir~ 
cumstances which were not the cause of the insanity. 



# NIGHT MARE. 

This* is a partial derangement of the brain in sleep: and it 
most commonly attacks the indolent, and those eating unusu- 
ally at night; which shows that it arises from sympathy with 
the stomach. The subject is here introduced to show the cau- 
ses, that they may be guarded against. It is a most distressing 
complaint, attended with the most horrid dreams of dangers, 
of strangulation, and the like: and continues a little after the 
person wakes. It has led to the question, whether it were bet- 
ter to be a beggar all the day, and in dreams a king all the 
night; or a king all the day, and a beggar all the night. Those 
who value undisturbed repose, and dread much the affliction, 
will do well to take exercise freely, and live most regularly, at 
least for the half of the day preceding the night. It is a good 
precaution for those subject to the disease, to sleep with some 



441 

one to rouse them, on feeling" their convulsive motions: for re- 
ally they not very unfrequently end in death. On av r akening, 
a glass of cordial may be given; but in full stomachs, a vomit 
is better. 



KINGS EVIL. 

This complaint is called Scrofula. It consists in hard indo- 
lent tumours, or lumps, of certain glands in various parts of the 
body, particularly the neck, behind the ears, and under the chin; 
which after a time suppurate, or, in common language, come 
to a head, and, discharging the contents, leave sores, from which, 
unlike from simple sores, there is discharged a white curdled 
matter, somewhat resembling the curd of milk. The first ap- 
pearance of the disease, is usually between the third and seventh 
year; but it may arise at any age before puberty, after which, it 
seldom comes on. It is most apt to attack children having a 
tendency to rickets. 

The disease is not contagious, but is hereditary, and is often 
received by the child from the parents. The child is not born, 
with the disease; but receives an aptitude for it, to be excited 
by the exciting causes when they come into operation. The 
disposition or aptitude for this disease, as in others of the same 
class, sometimes does not appear in the immediate descendants 
of parents, but does in the second or third generation. 

The lumps, or tumours, gradually enlarge, and become more 
visced: the skin covering them, acquires a purple or dark look- 
ing colour, and, when much inflamed, form matter and dis- 
charge it through small holes: at first appearing somewhat like 
good matter; but it changes by degrees, and a white substance 
resembling the curd of milk, comes from them. 

The tumours at the same time gradually subside, while the 
sores open more and spread unequally in various directions.— 
In time, some of them heal; but other tumours quickly form in 
different parts of the body, and proceed in the same slow man- 
ner as those first described. 
Ff f 



442 

In some cases, other parts of the body become affected: par- 
ticularly the eyes and the joints, which last swell, and are ex- 
cessively pained by the slightest motion. The swelling and 
pain continuing to increase, deep-seated sores are formed, the 
bones decay, hectic fever comes on, and death terminates the 
malady. 

The cure of this disease is unquestionably very difficult. Its 
treatment is naturally divided into two periods. The first is 
that in which, without any local sore or other marked symp- 
toms of disease, there is sufficient evidence of a scrofulous pre- 
disposition to it in the system. The other is that in which 
some local sore or other scrofulous symptoms appear, which 
may interfere with the treatment of the constitution. 

The disease is promoted by the slow operation of a number 
of circumstances, which produce a gradual change in the con- 
stitution. Hence one f the first attempts to correct the sys- 
tem should be to change the circumstances of the patient — his 
residence, diet, and drinks. The languor and debility which 
prevail in this disease, indicate the necessity of wholesome air 
and nutritious diet. Wine will be proper when there is a want 
of tone in the stomach. 

To ward off an attack of the disease in those showing a pre- 
disposition to it, it is adviseable that they should daily take 
moderate and regular exercise; continued so long as to dispose 
to rest without endangering fatigue. Rubbing the surface of 
the body every night and morning, will aid the effects of exer- 
cise. Bathing in sea or common salt water, is one of the most 
effectual preventives; it very frequently causes the dispersion 
of tumours already formed. Cold bathing, to be serviceable, 
should be followed by a general glow over the surface of the 
body: and the patient should feel cheerful, and a keen appetite. 
But if it be followed by shivering and drowsiness, it should not 
be continued. Warm bathing has sometimes proved servicea- 
ble when the cold disagreed: and its efficacy is increased by ad- 
ding some stimulant substance to it. The clothing of scrofu- 
lous patients should always be comfortably warm, and flannel 
should be worn next the skin. Drinking a little sea water to 



empty f Ve bowels: or doses of neutral salts are necessary to 
keep the bowels open. All the articles under the head of alte- 
ratives should be tried in succession. 

The muriate of barytes is a medicine said to have been given 
with success, in doses from three to ten drops twice a day, ac- 
cording- to the age of the patient. By some, muriate of lime is 
recommended, as a medicine superior to this — about a drachm 
of the solution for adults, and thirty drops for children, given 
in water twice or thrice a day, will be proper doses. But 
others have found it of no service. The hemlock, given in do- 
ses as large as the constitution can bear, and continued foVfive 
or six weeks, has been deemed serviceable: also the fresh leaves 
of the tusselago or catts foot, or a strong decoction of the dried 
leaves; lime water and the alkalies; the Peruvian and other to- 
nic barks; a gentle mercurial course, are remedies occasionally 
of considerable efficacy. 

Of the mineral tonics, iron, the sulphuric and nitric acids are 
esteemed the best. The mineral waters of the sulphurous and 
chalybeate class, may likewise prove serviceable. Arsenic has 
been employed with advantage, and has contributed greatly to 
the cure of scrofulous sores. 

For the external remedies of scrofula, on the appearance of any 
tumour or the enlargement of the parts around joints; you are 
to endeavour to prevent its degenerating into the formation of 
matter. The proper applications are those of lead, crude sal 
ammoniac in solution, camphorated spirit, and oils: a mixture 
of fresh bile, plasters of soap, sea-water poultices, mercurial 
ointment, electricity, galvanism, poultices of the sea-tang, Sec. 
are to be tried in succession. Bleeding from the tumours by 
leeches or cupping, is often serviceable in those cases where 
large glands lie near the surface, and are inflamed. 

The application of blisters to glandular swellings, have often 
proved of service; giving to the parts a healthy action, or caus- 
ing the dispersion of the tumours. 

When attempts fail to disperse the scrofulous tumours, and 
a suppuration has commenced, it is adviseable to expedite it. 
For this purpose, poultices are generally injudicious. Wash- 
ing the part with sea water or strong brine, is recommended. 



The tumours should be dry cupped two or three times a day, 
and then warm poultices are found serviceable. When matter 
is formed, an opening with a lancet may be made for its dis- 
charge. 

The sores, when there is much luxuriant growth, (proud 
flesh) should be sprinkled with red precipitate, verdigris, or 
burnt alum. When their action is languid, they may be stimu- 
lated by washes of crude sal ammoniac, corrosive sublimate, 
lunar caustic, or white vitriol; which last, from half to one 
drachm in a pint of water, is esteemed the best application by 
Dr. Goodlad. 

The application of linen cloths dipped in cold sea or lime 
water, and renewed as they become dry with a plaster of lead 
ointment at night, is recommended. Such sores have been 
variously treated: a weak solution of nitric acid, in irritable 
sores a watery solution of opium, and then a solution of white 
vitriol, are recommended. An ounce of soda in a quart of wa- 
ter, used to make bread into a poultice, to be applied to ill- 
conditioned looking sores. One drachm of borax to one ounce 
of ointment of calamine, has often healed sores resisting other 
treatment. The solution of arsenic should be tried, internally 
administered. 



RICKETS. 

This disease, as the last, should have been treated of among 
those of children, although Dr. Thomas has not done so. The 
characteristic marks are an uncommon size of the head, swel- 
ling of the joints, flattened buttock, bending of the back bone, 
and of the long bones of the limbs, protuberance of the belly, 
and general emaciation. It has been sometimes supposed to be 
a hereditary disease; it most affects poor and profligate people: 
and it is most excited by cold and damp places of abode, by 
impure air, uncleanliness, bad nursing, want of exercise, and 
general debility. It seldom appears before the ninth month, 
and seldom after the second year. 



445 

It usually comes on slowly: and the first appearances of it, 
are a flacidity of the flesh, emaciation of body, loss of colour in 
the cheeks, a slight swelling in the face. The head at the same 
time appears large, compared with the rest of the body, and the 
natural openings of the skull enlarge in infancy; the forehead 
becomes unusually prominent, and the neck very slender. — ■ 
Teething is tardy, and the teeth apt to decay and fall out; the 
joints of the limbs enlarge, and the intermediate spaces between 
them, become smaller, flexible and distorted. With these 
symptoms, aversion to motion increases, and inability to walk 
ensues; stools become loose and the intellect fails, till fatuity is 
complete. 

In some inland places — as in the interior of Switzerland, in 
Chinese Tartary, in the Pyrennes, and Leo Cevennes of France; 
this disease goes on to such an extent, as to reduce man to a 
state below the brutes of the higher order. It is called Cretin,' 
ism: but varies from our rickets only in degree. 

To cure the disease, we should invigorate the solids and pro- 
mote digestion. For this purpose you must administer tonic 
medicines, in suitable doses; give wine, good diet, moderate 
exercise by carrying the child laying down, as standing up might 
increase the deformity; the shower bath, frictions on the skin 
with flannels, and a free, open, dry air. Occasional slight vo- 
miting is of service, by agitating the contents of the belly, 
•with all parts sympathising. 

Sometimes the administration of lime water, and potash of 
soda, have proved of service. In this disease, however, the 
principal advantage, Dr. Thomas very truly says, is to be de- 
rived by general treatment: change of residence being not the 
least important. But as the poor cannot change their resi* 
dence, their children, when labouring under it, should be made 
to live in the highest parts of their houses, which are to be 
kept well ventilated. 

SCURVY. 

The characteristics of this disease, are debility, bleeding of 
the gums; spots of different colours on the skin, for the most 



446 

part livid, particularly at the roots of the hairs; occurring in 
cold countries after living on unsound salted meat, with a de- 
ficiency of fresh vegetables. It most frequently affects sailors 
and persons excluded from fresh vegetables. 

This disease comes on gradually with heaviness, weariness, 
unwillingness to move about, dejection of spirits, anxiety, op- 
pression about the heart; the countenance becomes sallow and 
bloated; breathing is hurried on the slightest motion; the teeth 
become loose, the gums swelled and spongy, and bleed on the 
slightest touch; the breath is very offensive; livid -spots appear 
on different parts of the body: and wounds long healed up, are 
apt to break out afresh; severe wandering pains are felt; parti- 
cularly at night, the skin is dry, the urine small in quantity; 
the pulse small, frequent, and, towards the last, intermittent. 
At length, in its last stage, the joints swell and become stiff- 
emaciation becomes general; bleedings occur from the nose, 
ears and fundament; the stools are foetid, and a purging comes 
on, which speedily closes the scene. 

The treatment, when practicable, should be commenced by 
changing the diet: giving raw and fresh vegetables of all kinds, 
preferring those of an acid kind; and the fruits, lemons, limes, 
oranges, sorrel and the like, may be taken freely. 

Mr. Patterson recommends the administration daily of one 
or two table spoonfuls, three or four times a day, of a solution 
nitre in vinegar, made with three or four ounces of nitre in a 
quart of vinegar; and this he also recommends as a proper 
wash for the sores occurring in this disease. Finely powdered 
bread charcoal, is a proper application for the mouth and 
gums; and some of it ought to be swallowed — two or three tea 
spoonfuls as many times a day: finely powdered, it is very good 
for the sores occurring in this complaint; and gargles of bark 
and astringent decoctions are proper. These sores are some- 
times with advantage washed with lemon juice, or a tincture 
of myrrh and of bark in equal quantities, and then dressed with 
simple ointment. A paste of oatmeal, is highly recommended 
for such sores, after they are washed with a solution of the 
sugar of lead. 



447 

In the course of the disease, the bowels should be kept open; 
best done by tamarinds or cream of tartar. The skin should 
be kept dry by warm clothing and small doses of antimony. 

To restore the strength of the system, a course of tonic me- 
dicines should be prescribed — such as bark, mineral acids, 
&c: at the same time breathing a pure air, and doing all he 
can to promote general health. 



JAUNDICE. 

This disease is marked by a yellowness of the skin, particu- 
larly observable in the whites of the eyes; by a bitter taste in 
the mouth; a sense of pain or uneasiness in the right side; the 
excrement whitish, or clay coloured; and the urine obscurely 
red, tinging things dipped into it, of a yellowish colour. It is 
produced by an over-secretion of bile: but most commonly from 
obstructions in its passages to the bowels. Those exposed to 
the effects of a hot climate, to violent passions and fevers, and 
those freely drinking spirituous liquors, are most subject to 
this disease. It is produced, in short, by whatever affects the 
liver: and is followed by symptoms of disease in that organ, 
and by those affections following obstruction to the passage of 
the blood from the stomach and other parts concerned in the 
digestion of our food. 

Small stones are sometimes fdrmed in the duct which car- 
ries off the bile, and the jaundice from such a cause is difficult 
to cure. Vomiting in such cases, is proper; as well as occa- 
sional purging. When the symptoms of inflammation are con- 
siderable, bleeding is proper from the arm, and free cupping 
the right side. In general, the disease may safely be treated 
as recommended for chronic inflammation of the liver, by a 
continued course of mercury for five or six weeks; by the nitric 
acid, and frictions on the skin until it becomes sore; with exer- 
cise on horseback. 

Large doses of soap; or, what is more agreeable, doses of the 
mild potash or soda, repeated three or four times a day, have 
been found of considerable efficacy, and should always be tried 



V 



448 

Doses of a mixture of sulphuric ether three parts and oil of 
turpentine two parts, in quantity about a desert spoonful, every 
morning, it is believed have destroyed the biliary stones. 

For the distressing symptoms of pain and sickness at sto- 
mach and for costiveness, the ordinary remedies should be ap* 
plied: — warm applications to the pit of the stomach, stomachic 
medicines, and laxative injections with small quantities of 
purging salts. 



GRAVEL AND STONE. 

This is an affection arising from the secretion of the urine, 
whereby matter is formed, which on being deposited and con» 
solidated, forms the gravel or stone. The substance formed 
is an acid, called the uric acid. Those in the decline of, and 
who have led a sedentary, life, are most subject to this com- 
plaint; excepting children from infancy to about fifteen years. 
The poor of the male sex are most subject to it. 

A fit of gravel is attended with a fixed pain in the loins, 
numbness of the thigh on the side affected, sickness at stomach 
and vomiting, and with difficulty in voiding water. As the 
irritating matter descends from the kidneys to the bladder, it 
is apt to produce excruciating pains, occasioning fainting. 
The deposite of reddish brown sand, resembling coffee grounds, 
from the urine on its becoming cold, will show the difference 
between this disease and an inflammation of the kidneys. — 
When gravel has once formed, it continues to increase by re- 
ceiving on its surface new layers of the matter forming the 
stone. 

The symptoms attending a stone in the bladder, are a fre- 
quent inclination to make water, which flows in a small quan- 
tity, is often suddenly interrupted, and is voided at the close 
with a pain in the head of the penis. The patient cannot bear 
any rough motion, and frequently has pain in the neck of the 
bladder, a disposition to stool, itching and uneasiness about the 
fundament, with numbness and a retraction of the testicles. 



fc 



449 

The gravel in females may often be relieved, by the introduc- 
tion of a tube into the urethra, and keeping it there, gradually 
enlarging its size so that it dilates the parts, and may suffer the 
extraction of the stone. 

In men, the operation for its extraction called lithotomy, is of 
a much more serious nature, and it is needless here to explain 
it. The palliative remedies, are those detailed under the heads 
of anti-acids, and anti-lithics, to which, I refer you. The me- 
dicines should be taken on an empty stomach long continued, 
and in large doses: the best alkalies, potash, and soda, in their 
mildest state, are generally proper; but of late small doses of 
magnesia have the preference. 

During the fits of pain, occasioned by a stone in the bladder; 
it is adviseable to inject into the bladder warm water, to 
change the position of the stone and to allay irritation. The 
water should be slowly injected. The general warm bath 
should be tried to alleviate the pain; and bleeding is proper 
when there is danger of inflammation, as well as the mild, 
mucilaginous drinks. Opiates may be given, and also injected, 
to allay the irritation. Sometimes cold applications of snow 
or cold water, to the back, have done great service. 

The diet should be of the mixed vegetable kind, and the 
drinks of soft water; acids are thought injurious. The follow- 
ing preparation has rendered good to many: take a handful of 
the garden leek, and a few sprigs of fennel, with two quarts 
of water, which is to be boiled half away, then strain it, and 
drink about a pint a day. 



TETANUS CRAMP, OR LOCK-JAW. 

This is an involuntary and almost constant contraction of se- 
veral or all of the muscles of the body, while the senses remain 
perfect and entire. It is an original disease, or symptomatic 
of some wound. It attacks persons of all ages. The original 
chiefly occurs among children in warm climates. That which 
arises from wounds is common in all countries: and it is this of 

G g Z 



450 

which I shall write. It is most apt to occur after punctured or 
lacerated wounds. 

In some instances, tetanus comes on suddenly, and with great 
violence: but generally its approaches are gradual; in which 
case a slight stiffness is at first perceived in the back part of 
the neck, which after a time increases considerably, and at 
length renders the motion of the head both difficult and pain* 
ful. With the stiffness of the head, there is likewise an uneasy 
sensation at the root of the tongue; difficulty in swallowing; 
great tightness across the chest, with a pain at the breast bone, 
shooting to the back. A stiffness takes place in the jaws, 
which soon increases to such a degree, that the teeth are im» 
moveably joined together. 

The spasmodic cramp then increases, affecting other parts; 
causing the back to bend backwards: the muscles of the belly- 
are contracted, and feel very hard; and the limbs are kept firm- 
ly extended; and at length it is the same with the neck and 
back,— -so that all parts are immoveable. 

The spasms, which at first occur every ten or fifteen minutes, 
besides being brought on by the slightest movements of the 
body and pressure on the belly, are in the advanced stages ex- 
cited by the presentation of any substance to the lips, resem- 
bling the effects of canine madness. The disease is one of the 
most dangerous kind, and generally proves fatal when it arises 
from wounds. Nevertheless attempts to relieve should be 
made. Any foreign matter in the wound, is to be removed: 
the wound should be dilated, and dressed with the oil of tur- 
pentine, or blistering ointment, or any thing to excite it to the 
formation of matter, when warm poultices are to be applied to 
promote the discharge. 

The following plans of treatment are recommended. The 
bowels are to be kept open by laxatives or injections. The pa- 
tient should be stimulated by laudanum and wine in large doses, 
and increased in proportion to the urgency of the case: not re- 
garding the quantity taken, but the effects produced; as in some. 
instances the quantity given has been astonishingly great, be- 
fore the convulsions were removed. Towards the decline of the 
disease, bark and wine are requisite: the ex- Uement of a blis 



451 

frer down from the neck along the back bone, by Spanish flies 
boiled in oil of turpentine, has been thought of great service: 
pouring a watery solution of opiu'm or laudanum on the wound, 
and rubbing the body with the same — has been used with ad- 
vantage. Some have as warmly recommended salivation as 
others have opposed it. 

The warm bath has been found serviceable; but much more 
so, throwing a bucket of cold water on the patient every two 
hours, when he is to be wiped dry and returned to bed; but it 
is not to be repeated, unless followed by a glowing sense or re- 
action of the system. 

Doses of ether, musk, camphor, and the tincture of Spanish 
flies, have been thought good: injections of five or six grains 
of tartar emetic, every two or four hours, I think might be of 
service; and the more so, as Dr. Thornton has found free purg- 
ing efficacious. 

When the patient cannot swallow and the front teeth will not 
admit of the administration of liquids, one or two teeth should 
be extracted to allow of its introduction. 

To conclude this subject, I repeat that the stimulation by 
opium and wine, in the largest doses and frequently repeated, 
constitutes our best dependence in the treatment of this dis- 
ease; with blistering all down the back bone, and using poul- 
tices wet with laudanum on the sores. Though I have seen all 
this done, and the patient expire drunk, profusely salivated, 
freely blistered, and drenched in cold water. 



SORE LEGS. 

The difficulty of curing sore legs, has been complained of by 
physicians in every country. Dr. Rush very judiciously re- 
marks, that this difficulty is attributable to the indiscriminate 
mode of treating them, originating from a defect in a proper 
theory to explain them. He considers them as arising from 
general debility — operating on the whole constitution, but cen- 
tering more particularly in the legs, in consequence of their 
remote situation from the heart, and the column of blood they 



452 

have to support, which overstretches the blood-vessels. The 
causes which induce them, act more or less on all parts of the 
body. Fevers and dysenteries often terminate critically in such 
affections; and consumption and apoplexy have often been pre- 
ceded by the suppression of a habitual discharge from a sore 
leg. The remedies to cure them, are those which operate on 
the whole system, or only on the part affected. 

Blood-letting is a remedy of great efficacy in all cases where 
the general system labours under fever; gentle purges, nitre in 
doses of fifteen or twenty grains, three or four times a day; a 
temperate diet; cool and pure air, and rest in a recumbent po- 
sition. 

The local remedies are, cold water to be poured on the leg; 
soft poultices of bread and milk, on the surfaces of which is to 
be put a little olive oil or mild lard; and when the inflammation 
subsides, strips of adhesive plaster so applied as to draw the 
sound edges of the sores together. 

Above all, rest and a horizontal posture of the body are to 
be particularly enjoined. 

In sore legs attended by too little general and local action, 
the strengthening medicines are to be given — as bark, mercury, 
iron, copper, and zinc, with a nutritious and moderately stimu- 
lating diet. The doses of these medicines are mentioned un- 
der the head of tonics. Rest and a recumbent posture, are 
not good in this species of sore legs. 

Opium is not only useful in easing the pain of a sore leg, but 
co-operates with other cordial medicines in invigorating the 
whole system. Tight bandages from the toes up the leg, to 
support the vessels, are very proper in this state of the system. 
Red precipitate and blue vitriol have been used with success 
in stimulating the parts, and so have infusions of Peruvian 
and white oak barks, the water in which smiths cool their iron, 
lime water, bread dipped in a weak solution of green vitriol, 
rags wet with brandy or spirit, and so on. 

It is of the utmost consequence, in the treatment of sore legs, 
to keep them clean by frequent dressings and washings. Dr. 
Rush further adds that the success of old women in treating 
such affections, is often derived from their great attention to 



453 



cleanliness, instead of any particular virtue in their applica- 
tions. These local applications, however, sometimes succeed 
and sometimes fail; and hence it is requisite to try them in suc- 
cession, until one is found to answer. Sores of other parts of 
the body, are to be similarly treated. 



SORE EYES. 

There are but few affections of the body, more difficult to 
relieve than sore eyes: or which are sometimes more singular- 
ly relieved by treatment apparently opposite to every princi- 
ple in medicine. 

It will be needless to make any observations upon such affec- 
tions as require surgical operations. But it is of very great 
consequence to impress on your minds, the great importance 
of f-*ee evacuations when the part is inflamed. Attention to 
this subject would have saved the sight of many who have be- 
come blind. The cooling treatment should be carried to an 
extent equal to the degree of the inflammation. The general 
bleeding should be extensive, as well as cupping or applying 
leeches near the part. Sometimes the cutting of the blood- 
vessels, or the red lids, with the point of a lancet, has done 
great good. The patient should be freely purged: and his diet 
and drink of the least heating nature. He ought to be confin- 
ed in the dark, and keep rags wet with a cold solution of lead 
water constantly on his eyes. It should be made not to smart. 
Dr. Dorsey recommends, as the best wash he has tried, the fol- 
■ low in : To four ounces of water add sugar of lead five grains, 
white vitriol three grains, and two drachms of laudanum; to 
which is sometimes added two ounces of vinegar. A similar 
solution of white vitriol, may be tried of greater strength. I 
have known poultices of rotten apple, and of scraped potatoes, 
when frequently renewed, to prove serviceable; as also applica- 
tions of fresh sweet oil. The dropping a little molasses into 
the eyes has been found serviceable, where the inflammation 
had continued some time The simple, lead, mercurial, and 
tar ointments have been applied to the lids with advantage; and 



454? 

also the citron ointment. Washes of brandy or spirit and wa- 
ter, have occasionally proved serviceable. Tar water, a little 
weakened, is also frequently used in long continued affections 
of the kind. Dr. Physick recommends the eye to be shut, and 
all over and around it a blister plaster to be put: it should be 
made of the most adhesive ointment, and thin gauze put over 
it to prevent the flies from entering the eye. This is unques- 
tionably an important remedy, in diverting inflammation from 
within. But sometimes it does not succeed; and it is recom- 
mended to speedily excite a salivation. 

In the employment of eye water, rags wet with the fluid 
should be placed over the eye lids, which are occasionally to 
be opened to allow the liquid to come in contact with the ball 
of the eye. 

It is scarcely necessary to observe that when inflammation 
arises from foreign bodies in the eye, they should be speedily 
extracted from them. 

Vomiting by doses of tartar emetic, has been employed with 
great success by many in inflammation of the eyes. The pow- 
der of fox-glove snuffed up the nose, has been found very use- 
ful in producing a discharge from it, and thereby lessening the 
determination to the eyes. I suppose powdered Spanish flies 
also useful with snuff. 

When the eyes secrete a matter which glues them together 
after sleep, their edges before sleeping should always be an- 
ointed with a little pure tallow or lead ointment. 

When white specks have been formed on the eyes, after the 
entire subsidence of all inflammation, they have been removed 
by absorption, on the application from the blunt point of a fea- 
ther, of a little beef or hogs* gali. The application of a little 
ether on the point of a cammel hair pencil, has produced the 
same effect, especially when the opaque speck proceeds from 
mechanical injury done to the eye. 



SCIRRHUS AND CANCER. 

Scirrhus, is a tumour in a part with little or no inflam- 
mation, often seated in glandular parts, as the breast of wo- 



455 

men and testicles of men; but occasionally affecting all parts.. 
When it breaks out into a sore, it is called a cancer, the cha- 
racteristics of which are, an uneven surface, rugged and pain- 
ful edges; it spreads rapidly, discharges a thin, acid, offensive 
matter, that corrodes the neighbouring parts. It usually be- 
gins with a small snuffing in the part unaccompanied by pain 
or change in colour. It gradually increases in size and hard- 
ness, and in time, becomes most painful, as if sharp points 
were sticking in it. And then continuing, according to the 
constitution of the patient, it bursts, discharges its foeted mat- 
ter, and progresses, until some vital parts are affected, which 
produces death. 

Although scirrhus tumours, sometimes remain in an indo- 
lent state for years; I believe but little doubt is entertained, 
that the best practice is to have them early cut out, with a 
knife. — To ascertain if the tumour be really of this nature, a 
very experienced surgeon is necessary. The part affected, 
should never be compressed, by clothing — picking and hand- 
ling are injurious. Applications of a cooling nature, may be 
tried, such as a solution of sugar of lead, half a drachm to the 
pint with a drachm of laudanum. The bowels should be kept 
in an open state, and stimulating drinks refrained from. Blood 
may be drawn near the diseased part by leeches or cupping.— 
Blisters on the tumour, when not discoloured and not inflamed, 
have been thought serviceable. The general warm bath, will 
be proper. To allay pain, opium may be administered inter- 
nally. A course of mercury, in the commencement of the tu- 
mour, has been thought an important remedy, though injuri- 
ous in the latter stage. The extract of hemlock, in pills, two 
grains, taken from one to ten times in twenty-four hours, until 
the head and stomach are affected, has been recommended in 
such indolent tumours: also the bella-donna and the hyoscy- 
amus. 

When the sore is formed, it may be washed with a very 
weak mixture of nitric acid in water, and dressed with finely 
powdered charcoal, to stop the offensive smell; the coal should 
be fresh, to act most effectually. The fomenting charcoal 
poultice, is sometimes preferred. To prevent the corrosion of 



456 

the surrounding parts, they should be frequently covered with 
lead or simple ointment. To arrest the pain, opium may be 
given internally, and a watery solution of this medicine appli- 
ed to the sore, and kept on by cloths dipt in it. Poultice s of 
henbane, night shade, and hemlock, are recommended; also of 
carrots. — Three drachms of borax in half a pint of water, has 
often proved a good wash for these sores; rags wet with it are 
constantly to be applied. 

Corroding applications to eat out the cancer, as it is termed, 
have been occasionally found serviceable, and unquestionably 
the best of these are made of arsenic. Equal parts of white 
arsenic and flowers of sulphur, form a powerful application, 
which may be weakened by the addition of coal or meal. Two 
or three grains of arsenic with a drachm of calamine stone, 
and sprinkling a little of the powder to cover it every day, 
until it is removed, is esteemed a valuable application. Fow- 
ler's solution of arsenic, internally given, has been thought ser- 
viceable. A solution of muriated barytes, in doses from three 
to ten drops, twice a day, have been tried with advantage. 

Several have highly recommended the applications of iron, 
in preference to all others: an ounce of the sulphate of iron, in 
a pint of w r ater, or the acetate of iron, in solution, are to be ap- 
plied to the sores, by folds of linen wet with them. The car- 
bonate, arseniate, or phosphate of iron, made into paste by 
water, and applied over the sores, once in twenty four hours, 
are preparations recommended by Mr. Carmichael and Mr. 
Denman. 

In every species of open cancer, the air should be excluded 
as much as possible; and therefore a covering of double oiled 
silk, may be put over the dressing. 

A new mode, by pressure, has lately been tried with success, 
by Mr, S. Young, in the treatment of cancerous tumours and 
sores. It consists in the application of suitable plaster straps, 
of sheet lead, of various thickness, tin plates, linen in folds, and 
appropriate rollers. The degree of compression, is to be gra- 
dually increased. In cases of open cancer, the wound is to be 
filled with powdered chalk, and the surface well dusted with 
hair powder, after which the pressure is to be applied as in 



437 

cases of scirrhus tumours. The best straps, are those made of 
equal parts of common strengthening and soap plasters, mixed 
and spread rather thin on linen. The plaster should be uni- 
formly smooth, and in the application of the straps, it is impor- 
tant there should be no wrinkles in the skin, that the pressure 
be equal, and no irregularly binding band be about the parts 
to affect the circulation. 



RUPTURES. 

This is an unnatural protrusion of some parts of the contents 
of the belly, generally the bowels; and its chief danger consists 
in pressing the part which protrudes, so as to produce mor- 
tification. The extent and danger of the disease increases 
with time: and it is apt to be brought on and augmented by 
any violent exertion. 

The first impression I wish to make on this subject is, that 
ail who have affections of this kind, should wear an instru- 
ment called a truss, to keep the bowels in the belly. The 
form of this depends on the part where the rupture is; and the 
instrument should be at first adapted to the part by a surgeon. 
One great precaution* is, on applying the truss, the patient 
should lay down until his bowels go up, when the instrument 
is to be put on: and never should it be put on so as to compress 
the parts protruding, as it may produce the mortification it is 
designed to prevent. 

The patient in laying down, should have his buttock elevat- 
ed, if the rupture be about or below the groins. He might a 
little time be held on his head, if there be difficulty in reducing 
it. On using common, equal and continued compression with 
the hand, and finding it to fail, you may apply cloths taken from 
cold water. Ice has been used with advantage, when kept on 
for some time. This failing, he should be bled standing up, 
until he nearly faints, when the reduction may probably be 
effected. The warm bath continued one or two hours, has 
produced a similar relaxation. An injection of ten grains of 
tartar emetic, may be given ty excite. purging, as well as relax- 
Hhh 



. 458 

ation of the system. An injection of one drachm of tobacco, 
infused in a pint of boiling water for ten minutes, may be given 
one half at first, and in case of failure, the remainder in half an 
hour. Sometimes a weight equal to two pounds, of lead or 
iron, has been kept on the protruded part or tumour for some 
hours; and it has succeeded in causing its receding. Mortifi- 
cation is so apt to ensue in these cases, that I cannot urge yon 
too strongly to call in early, the best surgical aid. 



THE ITCH. 

This is an affection of the skin, much favoured by cold, and 
tilth, and propagated from one person to another, by coming 
in contact together, or sleeping in the foul clothes of those af- 
fected. It shows itself in small pimples about the fingers, 
wrists, hams and waist; which are small, and of a white colour, 
attended with a constant desire to scratch, greatest at night. 

The disease is frequently cured by washing in strong lye. 
The ordinary applications are those of sulphur and mercury. 
Sulphur with hogs lard made into an ointment, has been fre- 
quently used; but this filthy preparation may be superceded by 
rubbing the dry sulphur on the skin for three or four nights, 
successively, and then washing well with strong soap suds. It 
is better to aid the operation by taking a tea spoonful of it in 
milk, two or three times a day. 

Some give a preference to curing the itch, by rubbing mer- 
curial ointment on the skin, every night for several nights. — 
The danger of salivation ought to banish this mode of treat- 
ment. When mercury is to be used, it is better to dissolve 
a drachm of corrosive sublimate, with twice the quantity of 
crude sal ammoniac in a quart bottle of water, and wash the 
parts where eruptions prevail night and morning, for three or 
four days. 

An excellent ointment is made by a drachm of sulphuric 
acid rubbed up with two ounces of hogs lard. The disease 
may also be cured by the fumes of sulphur, made by burning 
sulphur on a hot iron, underneath a blanket which envelopes 



459 

the body — excepting the face. Decoctions of tobacco, have 
also succeeded when other means failed. 

Slight purging ought to be made in curing this disease; 
and when the remedies are discontinued, there ought to be a 
general washing and change of all clothing. 



RING WORM. 

This shows itself in small red pimples, which break out in 
a circular form, and contain a thin irritating fluid. It increases 
to a great extent when neglected, and proves detrimental to 
the whole system, which in that state requires free and repeat- 
ed purging, with change of diet and a course of sulphur. 

The local applications for this affection are very various, and 
some of a trifling nature succeed when those thought best, 
fail. They may be such as are used for the itch. Thirty 
grains of corrosive sublimate in half a pint of spirit, makes a 
good wash: mercurial ointment; mustard; strong vinegar; com- 
mon ink; the juice of our green walnut; a solution of borax in 
vinegar, as strong as it can be made; lime water; and strong 
lye, have severally been found efficacious. 



BLOTCHED FACE. 

When this arises from too high living, it can only be reliev- 
ed by abstinence, and by a course of mercury when the liver is 
affected. Washes of strong solutions of sugar of lead, and of 
white vitriol; of decoctions of tobacco and Jamestown weed, 
have been found serviceable in lessening the red appearance. 

The white pimples or bumps on the face, may be relieved by 
exercise on horseback, by frictions on the skin, occasional purg- 
ing with neutral salts, and by washes of weak solutions of sugar 
of lead or white vitriol, and by low living. Great cleanliness 
and frequent bathing, may be considered as the most certain 
remedy for such affections, with frictions all over the surface of 
the body. 



460 



FALLING OF THE PALATE. 

This is the vulgar term applied to the swelling of that part, 
back of the mouth, called the uvula; and is foolishly supposed 
to be connected with a lock of hair> which when pulled, is said 
to relieve the disease. The proper treatment is, to apply to 
the swollen part, a cold metallic body, as a spoon: a little red 
pepper and salt some use; but gargling the throat with a solu- 
tion of sugar of lead, or white vitriol, or alum, or decoction 
of oak bark, will answer. 



SWELLING FROM AIR IN THE BELLY. 

This disease is termed tympany. It consists in a violent 
swelling of the bowels, or cavity of the belly, by wind. It 
comes on sometimes suddenly, sometimes slowly. The belly 
feels very elastic, and when pressed, suddenly regains its state; 
it sounds like a bladder distended with wind. 

When the wind is confined in the bowels, it is to be evacuated 
by introducing a clyster pipe up the fundament and keeping it 
there for some time. A little ointment, or decoction of James- 
town weed, may be applied to the fundament, to produce a re- 
laxation. The medicines mentioned under the head of carmi- 
natives, may be successively given; as also the stomachics, cor- 
dials, and tonics, unless fever prevails,, which will require de- 
pletion,-^-warm bath, and purgatives. 

Gold water or ice to the belly: frictions on its surface, of 
camphorated oils, of volatile linament, and the like, should be 
tried, with a decoction of tobacco. The last resource is tap- 
ping the belly to let out the air. 



TUMOURS. 

These are formed in all parts of the body, and their contents 
vary exceedingly, as do their size and rapidity of growth. It 



46i 

is scarcely credible to what extent they enlarge, unless extir- 
pated, or relieved by either of the following- means: — blisters 
over and around them, to produce absorption; cold applications 
long continued; pouring cold water from a considerable height, 
out of a small spout: which last mode I have often known to 
effect their removal. 

Warts are cured not so much by», corrosives, as articles to 
irritate the surface and excite an overgrowth on the top, which 
produces death beneath, in the vessels unable to supply the de- 
mand for blood. Could not the same plan be adopted for other 
tumours? At least, I would think it worth the trial in cases 
where a surgical operation was rejected. 



LEPROSY. 

This consists in an eruption of copper-coloured spots, dis- 
persed over various parts of the body, somewhat insensible, of 
a glossy and scaly appearance; thickening of the lobes of the 
ears; falling off of the hair; hoarseness of the voice; offensive 
breath, and sores in various parts. In some it is attended with 
the most inordinate desire for venery; so that Monsieur Sonni- 
ni states that in the i .land of Candia, he noticed at Canea, 
great numbers of lepers, both men and women, banished with- 
out the gates of the city, living in miserable hovels; where they 
abandoned themselves to the greatest excesses of voluptuous 
irritation. They were sometimes to be seen, satisfying their 
disgusting and impetuous lust in open day, by the sides of the 
roads leading to the town near which they lived. In other ca- 
ses, the reverse of such desires takes place. 

The cure is to be attempted by a vegetable diet, by free bath- 
ing, great cleanliness, and a course of medicines termed alte- 
ratives. 

The disease is exceedingly rare in the United States; but is 
common in the West Indies; from whence it may be imported, 
as it is believed to be infectious, especially when the parties 
cohabit, or come in contact with' t*he. jafatter of the sores. 



46B 

The alteratives most recommended, are a mercurial course, 
or long continued doses of arsenic, of iron and bark, of nitric 
acid. The sores may be dressed with ointment made of hogs 
lard and powdered charcoal, or mercurial ointment. 

DISEASE OF THE HIP JOINT. 

■ 

This disease most frequently attacks children. In its com- 
mencement it is very insidious; sometimes preceded by no pain; 
a slight weakness and some degree of limping generally attend; 
a loss of appetite and disinclination to motion are observed. — 
A pain in the knee is a common symptom: and this deceives the 
patient and his physician, who apply prescriptions to that 
part; having no suspicion that the hip is the seat of the disease. 

In general, before the disease has made much progress, pain 
is felt near, the affected joint, and the limb appears longer than 
the sound one, arising from the bending of the pelvis or 
bones about the hips. Pain is felt on pressing the parts around 
the joint. The disease gradually increases; the whole form of 
the hip is changed, and the natural roundness of the buttock is 
lost. When the patient attempts to walk, the weight of the 
body is sustained almost entirely by the sound limb; the knee 
is bent, the thigh is bent forwards, pain is felt in attempting to 
straighten the limb; matter is formed in the joint, the bones 
decay, new openings are formed for the matter, hectic fever 
comes on, and the patient gradually sinks. 

The remedies, to be successful, Dr. Dorsey adds on this sub- 
ject, must be active. The patient should be confined to bed if 
possible, a bandage around the limb should be applied to keep 
the muscles quiet: a purge should be given of fifteen grains of 
jalap and sixty of cream of tartar, every day or every other 
day; the dose to be increased if the purging is not free. The 
patient improves under this treatment, instead of becoming 
emaciated. The diet should be low, chiefly of vegetables. — 
At the same time, a blister about the size of the palm of the 
hand, over the joint, should be kept constantly running. When 
matter is formed, poultices should be applied to allay irrita- 
tion, and the sores'' should be dressed with simple ointment. 



463 



WHITE SWELLING. 

This affects the knee, the ankle, and elbow joints, most 
commonly occurring in those of scrofulous habits, and increased 
by rhumatic affections, neglect, or badly managed sprains. 

The treatment is the same — perfect rest, low diet, purging, 
local bleeding by cupping and leeches: also blisters kept con- 
stantly discharging until the disease subsides. When the 
parts are violently inflamed, a poultice of bran and sweet oil, 
or flaxseed, around the joint will tend to lessen the irritation: 
cold lead water, or crude sal ammoniac one ounce in vinegar 
and water, alike one pint, on the inflamed parts, have a simi- 
lar effect. Gentle frictions with the palm of the hand, may 
afford some relief. 

HICCOUGH. 

This is a convulsive operation of the membrane and fleshy 
part which separate the contents of the chest from those of the 
belly, having its origin in the stomach. Drinking two or three 
tumblers of cold water, a dose of magnesia or salt of tartar, a 
little vinegar and water, half a tea spoonful of ether in water, 
or news to excite astonishment or great surprise, have several- 
ly succeeded in removing this complaint. 



STUNNING BLOWS ON THE HEAD. 

The old manner of treating these, was to stimulate with wine 
and pungent articles. No practice more erroneous: because it 
has been found that the bruise is apt to be attended with effu- 
sion of blood underneath the skull. The proper application is 
a cold wet cloth to the part receiving the blow. The subse- 
quent treatment, is anti-inflammatory; rest, purging, bleeding 
first a little, then a little more, and to be increased with the in- 
crease of inflammatory symptoms. Remember the precaution 
I gave you on the subject of wounds of the scalp: — it is better 
to live too low than too high. 



464 



COLD FEET. 

With some, this is a very distressing complaint; and the on- 
ly means I have known successfully applied, is to pour a pitch- 
er of very cold water over the feet, wipe them dry, and then 
put on the stockings. 

PLAITED HAIR. 

This disease is a species of the scald head, termed fdica fiala- 
nica; very common among the peasantry in Poland and other 
interior parts of Europe. The hair is matted together, by the 
matter exuding underneath. The remedies are the same as 
for scald head: shaving the hair, close to the head, daily wash- 
ing it in strong soap suds, lime water, or decoctions of tobac- 
co; applying the ointment of Jamestown weed, or tar and mer- 
curial ointment, to destroy the vermin. A blister may be ap- 
plied to the back of the neck, and kept discharging for some 
time, when the disease has been of long standing. Purgatives 
should be given occasionally, to aid in lessening the determi- 
nation to the head. 

DIRT EATING. 

1 

This disease in some instances goes to a great extent, cor- 
rupting the whole of the bowels. 

The corrections are a generous diet, of animal food, wine 
and other fermented liquors. Stomachic bitters, bark and 
iron, should be administered in suitable doses, to give tone to 
the system; aided by frictions on the skin and gentle exercise: 
and occasionally a vomit will prove of service in revolutionis- 
ing the stomach. Those who have the disease, should not 
live on dirt floors, and should be watched while out. 

THE END 



iSt 



Hints respecting the Treatment of Domestic Animals, 

It will not require many words to communicate the impor- 
tant information I possess on this subject, in common with 
some others: but very much neglected by ninety-nine out of eve- 
ry hundred of the community. Two motives impel me to press 
the subject upon your attention. The first is a feeling of com- 
passion for our shamefully abused animals; the second is a de- 
sire to promote your interests. I pray you not to estimate ths 
value of the observations I have to make by their brevity: but 
by the spirit with which they are made, and the rationality of 
the advice. 

First, I wish to impress on you this most important fact, 
that your domestic animals — your horses and your cattle — are 
formed on the same principles, and their bodies governed by 
the same laws as your own. They are born with a capacity for 
life, called excitability. — Things operate on this capacity, call- 
ed stimulants; and the effect of them is excitement, or all the 
characteristics of animation. As with you, so with them,— 
over stimulation exhausts t'he capacity: the want of stimulants, 
produces disease, either at the time of an acute nature, or after- 
wards of a chronic nature; making them, as the exposed over- 
worked labourers, "old in youth — blasted in their prime/* 

The vicissitudes of climate destroy the constitutions of cattle, 
as they do those of men. Hence it is so rare for either to live 
in our country to a natural age; especially the former, so often 
cruelly exposed. 

To the man who treats his favourite horse better than he 
does his fellow-being — his servant or slave; I need say but little. 
He should understand that the excitability of the animal is ac- 
cumulated in his system, and that inconsiderable causes pro- 
duce excessive and diseased action. Hence the, numbers of such 
Iii 



466 

pampered horses "which die annually from violent inflammatory 
affections of the lungs, bowels and brain. 

To the man who treats his horse worse than he would a 
beast of prey, by overworking, half feeding, and that irregular- 
ly: who exposes him to the hardships of a powerful sun, and a 
blood-freezing cold, all within a few months — I will say, that 
independent of his brutality, he is acting as foolish as the one 
who destroyed his goose yielding golden eggs, in order to 
grasp the whole. 

In the name of common sense, let me entreat you to remem- 
ber that the more* you and your animal live in a state of nature, 
the longer will you live free from disease; and that your sense 
should be exercised, to counteract the irregularities of climate 
and the wants brought on by all artificial modes of living, in- 
stead of adding to the number. 

As you do, your cattle require, regular exercise, rest, undis- 
turbed sleep, pure air, and food properly administered; shelter 
from the excesses of heat and cold; a gradual change from all 
states to others. 

You must have observed the excellent order of waggon and 
plough horses — daily worked, well fed, and nightly allowed to 
rest. And this undisputed fact, is enough without argument, 
to teach the propriety of the practice. 

Of the air. — Our large animals breath or require more of it 
than we do. Hence they should always have it pure: the more 
necessary as its impurities produce not only immediate, as well 
as chronic affections; but epidemical fevers with them, as it 
does with us. We know that all men live better in country 
than in towns. Nevertheless, the absurd practice prevails of 
flocking these creatures; of packing them together in barns, or 
stables: not only breathing each other's impure air; but the efflu- 
via from their bodies, especially that from their urine and excre- 
ment. I have before stated my most anxious wish to demol- 
ish every large hospital, or receptacle of many of the poor. I 
have a feeling equally strong to destroy every stable in our 
country, where more than two horses or oxen could be con- 
fined together. There is but one proper mode to be adopted 
for shelter for these animals; and that is the most economical, 



467 

and the most improving to the animals, and to the land en 
which they are confined. 

LET THEM BE CONFINED IN COARSE, ROUGH 
BOXES, OF SUITABLE SIZE, OPEN AT ONE END 
ENTIRELY, AT THE OTHER END PARTIALLY; SUCH 
AS ANY LABOURER COULD MAKE OF THE COAR- 
SEST MATERIALS; AND WHICH COULD NOT AL- 
TOGETHER COST FIVE DOLLARS. I HAVE HAD 
THEM MADE FOR HALF THE MONEY ON MY FARM, 
WHERE PLANK IS CHEAP. 

The generality of stalls for horses, are made three and a half 
feet wide, and eight feet in length; six feet in height, is suffi- 
cient, — one hundred feet answers for the sides, and half as 
much for the top and end. This can generally be bought for 
two dollars, and the box made for fifty cents more, using either 
nails or wooden pegs to connect the parts together. By this 
contrivance each horse is kept breathing a pure air. From its 
flat roof the rain will pass off sufficiently when it is placed on 
the side of a hill: on the south part of which, the inhabitant 
will be kept sufficiently warm in winter, and on the north suffi- 
ciently cool in summer, at least when the box is placed under 
the shade of a tree. But these are not all the advantages: it is 
known that in all barn yards th£ best part of the manure and 
all the urine, are washed away by the rains; the expense of re- 
moving the remainder is felt considerably by all who undertake 
it. Now these boxes can be removed every week or fortnight 
on good ground. The ground will be enriched by that which 
is lost in a barn yard, and the manure on the surface can be 
pitched to the next spot of earth. The horse may by this plan 
be constantly kept on pure earth; the only kind of floor proper 
for him to stand on, and the only one he does stand on in a 
state of nature. Persons I know are very apt to overrate their 
own suggestions; but indeed I do sincerely believe, after mak- 
ing the most impartial calculations on this subject, that the 
advantages derived from it would be immense, if only confined 
to the exemption from diseases, which it would secure to the 
stock of every description. What man so poor, that he could 
not provide such a contrivance for his cow? Animals kept 



468 

warm in winter, do not require half the food they consume 
while shivering- from cold; and what numbers would be saved 
from the deaths brought on every spring on every farm, when 
the stock is without shelter. These countless deaths occurring 
in almost every place throughout the country, have their re- 
mote cause in the cold of winter. The warmth of the spring 
acts upon their accumulated excitability, caused by the ab- 
sence of the stimulous of heat in the winter, producing dis- 
ease — and the wonder is not why so many thousands perish, 
but why any escape. 

I beseech you, on the score of humanity, of economy, of fer- 
tilizing your farm, of preserving your stock from disease and 
death, provide such a contrivance for every one of them. The 
cost cannot be more than I have estimated; but if five times the 
amount, you will in one year save its cost. It is as necessary 
for your sheep as your horses and cows. The diseases prevail- 
ing among and annually destroying the large flocks, show that 
they ought to be kept in more detached parties. They require 
a pure air, shelter from rain, and they can fertilize your soil 
proportionate to their consumption. 

The next point to which I wish to turn your attention — is 
shelter from the sun. You see with what solicitude they avoid 
its rays; abandoning their food for the shade of a tree, during 
every hot summer's day. And it must be known to you, that 
thousands annually perish, in the field, and on the public roads, 
when forced to work, exposed to it. Humanity and interest 
alike, urge you to w r ork them under shelter. Provide the 
cheapest materials, fifty cents' worth of coarse cotton, or patch 
up rags, and make a small sheet for the working animal. Let 
it be put on him, but not next his skin. Any one having the 
sense of the commonest man, can make some projecting points 
on the harness, to elevate the cloth nine or twelve inches from 
the hide of the animal. The motion of his body, the circula- 
tion of air kept up by the heat between his surface and the 
cloth, will cause an evaporation of moisture, which will keep 
the horse or ox most pleasantly cool: and either will thereby be 
enabled to do as much additional work in two days, as will pay 
for the contrivance. 



469 

The food is of next importance. Two things about this, are 
necessary. First, that it should afford nourishment: and next, 
the stimulous of distension. You should remember the expe- 
riment I mentioned respecting* two similar animals equally fed: 
the one kept at rest, the other in motion; when, after a speci- 
fied time, each one was killed, and their stomachs opened; 
the one confined was found to have digested his food — the other 
not at all. This important fact should teach you to give your 
horse grain only at night, that he may digest it well; taking 
sound sleep, which he requires as much as you. Let him have 
no hay at night, for he will be constantly mincing at it; but in 
the morning and middle of the day, give him any of what is 
called long food, to which he is accustomed. In two hours he 
will eat enough of 9uch food, and more than he would have 
done all the night. Of this I have had ample experience. — 
Whilst making a most extensive journey, my horses were fed 
three times every day, and had hay at night; and they declined 
in flesh. On returning home, I pursued a different practice: 
gave them half a bushel of grain at night, without any hay; 
they slept well, and about eleven o'clock they were put to hay 
without grain. I travelled more than I did on going outjf and 
ray horses actually fattened on the way. The same experiment 
has been made by thousands, with like result; and whoever 
will observe this plan, will find his account in it: for it costs 
least money at taverns, and saves the dangers of foundering. 

In addition to the times of feeding, the state of the food 
should be considered. It is stupid folly to give grain in its liv- 
ing state; that is, having the capacity of growing. The diges- 
tive powers of the most healthy animals are scarcely able to 
overcome its life, or digest it properly. Hence we see in every 
road and every barn yard, in the manure of the animals, whole 
and parts of grains, which had done those that swallowed it, 
no more good than so much gravel would. If you think it too 
much trouble to send your grain to mill, then destroy its life 
by soaking it in hot water until it swells and sprouts. It will 
make it yield much more nourishment, and the animal will be 
more healthy. The only trouble this plan will give you, will 
be that of getting out the grain two or three days before it is 



4/7G 

wanted, and putting it in a tub of hot water, or in water expos- 
ed to the south sun. 

It is a fact well ascertained, that food boiled unites to water, 
and makes the water enter into the nourishment of our bodies. 

Hence, half a gallon of meal, boiled into mush with a gallon 
of water, will yield more support than three quarts of meal 
with the same quantity of water, taken separately. This ought 
to induce every one desirous of saving food, to boil it before 
giving it to stock. 

The stomach of an animal accustomed to one kind of food, 
will not readily digest another; therefore all changes in diet, 
should be made gradually. You may have observed the abo- 
minable stench of the excrement of horses fed on new corn. — 
The same, more or less, takes place on all changes in his diet. 
His support and exemption from disease in his bowels, require 
all alterations in his diet to be made by degrees. 

The dry feed for horses, I have found best, is wheat straw- 
far better than timothy or clover. But cows will eat any thing 
dry which they would green, if it be cured green. During a 
scarcity of food, this ought to be attended to. The leaves of 
gredfc trees cured, I have found an excellent hay — >as good as 
any I would wish for cattle. In the winter, you may have seen 
cattle eating the leaves of trees blown down in summer. Now, 
if these leaves, or small branches, be cut in summer and allowed 
to dry, they will devour them with much more facility. The 
leaves of the oak, the poplar, the willow, and peach tree, they 
generally prefer. 

In fattening hogs, it is desirable to do it so that they will ac- 
cumulate most fat at least expense. True the original flavour 
of the hog is not preserved; but people prefer the fat. Now to 
do this, the hog should be confined alone, where he can scarce- 
ly turn round. He should not be penned with others; for they 
exhaust themselves more or less with their mutual dissentions. 
And for his food, give dough of Indian meal, either boiled, or 
suffered to ferment for twelve or fifteen hours. I have added a 
little powdered charcoal with great advantage, in the way in 
which many fatten turkeys and geese. It is a fact, which any 
man who will make the trial will bear testimony to, that by 



471 

this plan, near one-half of the grain will be saved which is now 
consumed every fall in fattening pork. Within certain limits, 
the warmer the exposure for the hog, the quicker he will be- 
come fat. 

All observations on this subject, are applicable to every spe- 
cies of animal on a farm. Give them clean apartments, fresh 
air, shelter from the extremes of weather, pure food regularly 
given in the most digestible state: and you will find it impor- 
tant, from the horse to the chicken. 



DISEASES OF HORSES. 

The diseases of this noble animal are like those of men, and 
require a similar treatment. Dr. Cooper, in referring to re- 
lieving their eyes, says would to God the farriers could be pre- 
vailed on to leave off their cruel practice of blowing pounded 
glass and stone into their eyes. With equal feeling, I pray 
that the masters, instead of their stupid and conceited ostlers, 
would undertake the cure of their disorders by exercising com- 
mon sense on the occasion. 

As in the diseases of men, there are a great variety of names 
given to those of horses: and just about with as little propriety 
in the one case as in the other. Let me tell you the truth — 
that there is a great resemblance in the diseases of ourselves 
and horses: and they are to be cured on the same principles. — 
The chief of their complaints, general and local, are of the in- 
flammatory order, and commonly arise from their stomach and 
bowels: and the cure is to be effected by reducing the action of 
the system, by bleeding, clystering, purging and sweating, and 
low diet; by cold applications; and by producing counter irrita- 
tion by blistering, rubbing, cupping, and burning. Their low 
action complaints require stimulants and tonics of spirit, assa- 
fcetida, and the astringent barks of oak, dogwood, and willow. 

It is scarcely credible what ridiculous compounds are pre- 
scribed for horses and crammed down their throats every day. 
Pray let me entreat you to trust to none of these doses, or pre- 



scribers. I will briefly detail all that ought ever to be done to 
a horse. 

When he wants bleeding, any man of common sense can do 
it, with as much ease as any farrier. The operation is gene- 
rally performed in the neck; but the same directions for it, are 
applicable to all parts where it is desirable to take blood. Ap- 
ply a bandage around the part so that the vein shall swell.— 
With a razor shave the hair off the vein to be cut for about an 
inch and a half. With the same rasor, cut down through the 
skin and expose the blue vein for half an inch. Then with a 
common thumb lancet, or very sharp penknife, cut the vein 
open about as long as your nail, and have the blood caught to 
ascertain the quantity. 

Cupping is an important remedy. — Shave the part, cut 
through the skin in many places about half an inch long, and 
each gash half an inch a part. Then apply a suitable mug or 
gourd, with a little burning spirit, over the part; which will 
extract the blood as the air is consumed by the burning body. 

Blistering may always be done, by shaving the part and ap- 
plying powdered Spanish flies boiled in oil of turpentine.— 
Hard rubbing all know frequently to be very efficacious; and 
very rarely burning may be done to produce counter irritation. 

Horses may be purged by two ways: by pushing a ball down 
the throat, or giving a drench. The mode of giving drenches, 
is very improper as practised with bottles. The best way is 
to use a large clyster syringe, to hold out the tongue, and for- 
cibly squirt the contents down the throat— very easily done and 
no ways dangerous. Clysters may be given in the same man- 
ner: for which a strong solution of tartar emetic will generally 
answer, with introducing the hand and arm up the fundament 
to aid in drawing out the contents. 

To produce sweating by artificial means, it is best to confine 
the horse in a tight box, or have him well covered with cloths, 
entirely excluding the external air. A tub of water should be 
put under him, and red hot stones added to it until the steam 
is sufficiently hot to excite the sweating. Another mode is to 
cover him with a blanket dipped in hot water, to be renewed 
until the same effect is produced; and it may be effected by 



473 

keeping under cover standing on warm ground, from which the 
steam ascends. 

If you wish to purge a horse, it cannot be very material what 
purgative it is done with. — A pound of Glauber salts, is as 
good as any: so is a pint of castor oil; of warm hogs lard, or 
of molasses. The addition of ten or fifteen grains of tartar 
emetic to each dose, will expedite and improve the operation. A 
ball made of an ounce of jalap, or of powdered aloes, or two 
drachms of gamboge — to either of which, add ten or fifteen 
grains of tartar emetic. 



PARTICULAR DISEASES. 

Of Fever^ with or without local affections in the lungs or bowels. 

Bleed freely in proportion to the apparent disease and fre- 
quency of the horse's pulse. In a natural state, it beats about 
forty strokes in a minute. The bleeding is to be repeated, as 
with a man under similar fevers. Give free and repeated 
purges — of which give a preference to salts and tartar emetic; 
and repeat, as you would the bleeding. Let the drink be warm 
water. Give injections of a drachm of tartar emetic, until an 
irritation is produced in the lower gut. If not soon relieved; 
try a sweat, as above proposed. If there be any part visibly 
affected: apply a large blister over, and as near to it as possi- 
ble. Whenever the contents of the bowels are offensive to 
the smell, give powdered chalk in doses, of three or four 
ounces. 

For a Cough. — In proportion to its degree — bleed, purge, and 
drench with flaxseed tea. 

For a Flux. — Purge with castor oil, and add to it one drachm 
of calomel. Bleed if there be much pain and fever. Inject 
into the bowels one or two drachms of sugar of lead in a quart 
of water. Mix flaxseed with the food. 

For a Founder. — This is nothing more than an inflammatory 
colic, arising from eating food, when the horse cannot digest 
it. The best remedies are to bleed freely — to give a drench 
of salts: to introduce the arm up the fundament to cleanse the 
gut and produce dilation. An injection may be given, of thir- 
Kkk 



474 

ty grains of tartar emetic in a pint of water. If the spasm is 
not relieved, an injection of a drachm of tobacco, may be tried 
in a pint of water. The practice most commonly pursued, is 
to produce a sweat, by the means pointed out before. 

Over eating and distention of belly. — Horses sometimes over 
eat, and their bellies distend, in consequence of the grain fer- 
menting in their stomachs and generating fixed air. The 
remedy is to inject the above decoction of tobacco; to 
drench freely with lime water, which will absorb the fixed air, 
or with common lye. Bleeding may be tried, till the horse is 
much weakened: and also the warm bath. 

Of Worms.<— Three kinds of worms are noticed: — The bots, 
a small worm with a big head near the fundament. The trun- 
cheon, short and thick with black head, is found in the maw: 
also the maw worm, in the same place, of a pale red colour, 
like the earth worm. Horses affected with worms, have their 
bellies a little swelled and hard — they will frequently stamp 
the ground, turn around to look at their sides, and strike the 
belly with their hind legs, and groan considerably. The reme- 
dy is to purge them freely; and the best mode is to do it, by 
giving a drachm of calomel, with four of jalap, repeating the 
dose every other day for three or four times. He should take 
the medicine on a fasting stomach. Thirty grains of turbith 
mineral; is also a good destroyer of worms; also a purge of au 
ounce of aloes. 

Hide Bound. — This is generally known from the unhealthy 
look of the hair, and the adherence of the skin to the side. 
The disease arises from the stomach and bowels, and requires 
one or two purges with good sound food. 

Lamfias. — This is a swelling of the flesh immediately above 
the upper row of teeth. It is a common practice to burn 
or cut it out. It may be destroyed by an ounce of alum with 
as much white sugar, rubbed on the part two or three times a 
day, or by rubbing it with a mixture of half a pint of vinegar 
with an ounce of common salt — the same of the oils of turpen- 
tine and olive, to be rubbed on while warm, thrice a day. 

Surfeit. — This is an eruption of the skin — scales and scabs, 
swelled legs, unhealthy looking hair, &c. It most commonly 
arises from food disordering the stomach. It is to be treated* 



475 

by purifying the bowels, by purging with salts and tartar eme- 
tic, and by bleeding. The skin should be washed clean with 
soap suds, and then bathed with a solution, either of sugar of 
lead or white vitriol, or a decoction of oak bark, to subdue the 
inflammation. 

Strains. — Horses are as liable to these accidents as their 
riders: the remedies are the same: rest, low diet, bleeding and 
purging. The doing this fully at first, will save future pain 
and loss of service. Cold applications ought to be made on 
the affected part, of vinegar or lead water. The part affected, 
can always be ascertained, by the unusual feeling the horse 
shows on pressing on it. After the violence of the inflamma- 
tion has subsided — if the lameness continues — blisters on the 
part, kept discharging, will be necessary. 

Inflammation of the Weathers, called Fistula. — No disease to 
which horses are subject, is more improperly treated than this, 
or in a more cruel manner. It is brought on by the inju- 
dicious manner of putting on the collar or saddle. Whenever 
there is the least symptom of inflammation — bleed, and purge; 
but above all, apply ice, or cold water, or lead water, every 
hour or two until it subsides. I never failed in preventing 
these fistulas, by such treatment. When matter is formed, the 
best way is to open the abscess at its lowest part: to dress the 
sore with charcoal and suet; and to keep a blister running on 
the top, to lessen the tendency of the matter to form and pene- 
trate below. * 

Shrinking of the Shoulder Joint. — This arises from a strain. 
It is to be treated with perfect success, by keeping issues and 
blisters discharging over the part until the disease ceases. 

Inflamed Eye3. — Bleed, purge, low diet, lead water, to be 
constantly applied, and the eye sheltered from light. If the 
inflammation do not subside in a week or ten days; apply a 
blister over the whole and around the eye, after the hair is 
shaved off, as Dr. Physick recommends for our eyes. 

Wind G-alls. — These consist in an enlargement of the sacks 
around the joints of the feet. The only proper treatment is, 
to rub the parts very hard and often; if not successful, keep- 
ing a blister over the part, a bandage to compress a piece of 
lead or iron on them for a length of time, has cured them. 



476 

Puncturing- them, has succeeded; but it is dangerous, as they 
sometimes communicate with the joint. When a puncture is 
made, there should be injected a little brandy, to excite inflam- 
mation in the sides of the sack; and then the parts should be 
kept pressed together to insure their union. 

Wounds. — Wounds in horses are to be treated as with us, 
precisely; and to the mode I refer you. 

Sores. — These are generally on the back, produced by the 
improper application of the saddle. They should be washed 
with soap suds — then sprinkled with powdered charcoal, and 
covered with any common plaster to exclude air. But the best 
dressing is an ointment made of powdered charcoal, rubbed up 
with equal bulk of hogs lard. Any exuberant flesh, (firoud), 
may be destroyed, by burnt alum, or any article mentioned un- 
der the head of caustics. 

Poll Evil. — This is an abscess formed about the ears — gene- 
rally from blows. On its appearance, bleed, purge, and make 
cold applications. If still the inflammation progress, shave 
and blister all over the part, which keep discharging. When 
sores are formed, you must then cleanse and keep the parts 
always covered with charcoal or charcoal ointment. 

Grease or Scratches. — -This is an inflammation, followed by 
sores around the ankles, arising from keeping horses in dirty 
places and irregular use. The horse should be bled, purged, 
and kept on cool moist earth. During the inflammation, cold 
lead applications should be made. I once cured my horse by 
keeping him standing in a running stream of cold water up to 
his knees ten hours every day, for three days. Lead ointment 
is good for the sores in an early stage. Afterwards other oint- 
ments become necessary, and the variety recommended is equal 
to that for our own sores. The parts should be kept clean and 
washed with soap suds twice a day. A blister over the whole 
part may prove serviceable. An ounce of verdigres in a pound 
of basilicum ointment, has effected cures when others failed. — 
,The same ointment with oil of turpentine, has done the same; 
also citron ointment. Jamestown weed very frequently may be 
tried; but none should be continued, unless found to be curing. 
In obstinate cases, I would try running blisters or issues above 
the affected parts. 



*77 

Straining and difficulty in making Water. — This generally ari- 
ses from inflammation in the kidneys or bladder. The remedy 
is bleed, and purge freely with salts, and give an ounce of salt 
petre once a day, or as much potash or soda. 

For swelling from the heart along the under part of the belly, 
called Anticar, bleed and purge freely. To the swelled parts 
apply lard, and then a large hot bran poultice. When the 
parts form matter, the sooner it is opened the better. 



PRESERVATION OF MEAT AND FISH. 

I commence this subject with the declaration, that if the peo- 
ple could be prevailed upon to attend to the few brief remarks 
I have to make, they would save incredible sums of money an- 
nually. Indeed, 1 feel so sanguine about their tendency, that I 
believe near one-fourth of the cost of the consumption of the 
common food of the country would be saved. 

Salt, every body knows, is the main article relied on for cur- 
ing fish and meat. Yet there are very few who know that salt 
in small quantities, tends powerfully to promote putrefaction. 
Just now I do not remember w r here, twenty years ago, I read 
experiments to prove the fact; but well do I remember having 
frequently by experience ascertained its reality. Whence the 
absurd practice of partially salting, called corning, arose, I can- 
not tell. It originated in error, and is kept up by habit and 
prejudice. 

The greatest losses on this subject, are sustained at the fish- 
eries: where annually hundreds of thousands of barrels are lost 
by the practice. The only proper plan for you to adopt, is to 
put on the fish as much salt at once as ever you intend: and 
the sooner it is done after they are taken out of the water, the 
better. When it is intended for keeping them, it should always 
be done on the fishing shore. The fish should be immediately 
cleansed of all scales and parts never intended for use; then 
washed, and packed in salt. It is folly to leave any thing on 
them not wanted for use, as such offal wastes the salt and does 
no good. What brine comes from them ought to be preserv- 
ed, and purified by boiling; and as soon as the fish are carried 



to the place destined, they ought to be put in brine. There is 
much nonsense said about making brine: the only rational mode 
Is to put salt in cold water as long as it will dissolve, or become 
what is termed saturated. Water, hot or cold, Will only take 
up a given quantity, whatever may be that you put in; and thie 
brine will be as good every year afterwards as the day it was 
made. 

The curing of meat is no less improper: and more so sprink- 
ling it in summer with salt. With this as with fish, give it at 
once its full quantity of salt: and when it has taken enough, pre- 
serve it in similar brine. By this mode you may cure meat in 
a common cool cellar, as well in summer as in winter. The 
practice of many establishes this; although more fail, in conse- 
quence of not applying a sufficiency of salt soon after the ani- 
mal is killed. 

To preserve fresh meat in summer, it should be suspended 
in a wet bag, placed where there is a current of air; and the 
bag being often wet, will afford a sufficiency of water for gra- 
dual evaporation, to keep down the heat of the flesh. It is the 
same plan pursued in all hot countries to cool drinks. 

To preserve salted meat smoaked, is another object of no in- 
considerable importance. Its rancidity and liability to skip- 
pers, are sources of much annoyance. To save trouble, and 
either of those evils; as soon as the meat is sufficiently cured, 
have it well packed in barrels of powdered charcoal, or pure 
ashes; or have each piece covered with a bag of paper, and the 
whole packed in salt. In this state, one will not act on ano- 
ther. 

A practice prevails in the north of Europe, of killing and 
freezing all the meat they wish for the winter,, at the com- 
mencement of cold weather. It is objected to in our country, 
because the flavour of the meat is destroyed in thawing it for 
use. The objection is chiefly- grounded on the improper man- 
ner of thawing it. The proper mode is never to take it from 
the ice until about to be used: when it should be put in the 
coldest water and allowed gradually to thaw, rubbing the ice 
from it as it is formed; and then putting it in the pot in cold 
water for boiling. The flavour may not be so strong; but who 
has a right to make such a frivolous objection, that can eat half 



479 

rotten venison, pampered geese, disgustingly fat hogs, and stall- 
fed beef? Such should live in the woods, if they want their 
food according to nature. If every master of a family would 
determine on the first cold weather what he had to. kill: and 
kill the whole, and freeze it, and pack it up in ice; he would find 
in saving of food, in exemption from thefts, and in losses from 
death, a saving not much less than half. 

A Mr. Appert, a Frenchman, has proposed a new mode of 
preserving meat for years without salt; and he has carried it in- 
to practical operation. Instead of giving his pompous direc- 
tions about it, and attaching the importance he does to trifles; 
I will briefly state — 

First, after freeing it of the bones, boil whatever you have to 
preserve, in the way you commonly do; but only let it be about 
three-fourths done: then take the half of it out. Boil the re- 
mainder well and then strain the broth. A part of this broth 
may be preserved: the remainder is, with the other half of the 
meat, to be put in jars or large mouthed bottles, which are to 
be filled within an inch and a half of the top, and corked so 
tight as to exclude all chance of the admission of air. The bot- 
tles or jars, so filled and so perfectly corked, are then to be put 
in a boiler, so filled with water as to come up to the necks of the 
vessels. The water in the boiler is then to be heated and kept 
boiling for one hour. When the process ceases, and the water 
being drawn off in half an hour; the vessels gradually cooling, 
they are to be removed in an hour or two more, to be covered 
with rosin, and, if you please, a bladder; when they are to be 
put aside for use, with the mouths upwards. The meat, and 
the broth so preserved will be found good for two or three 
years afterwards. 

The heat favours the combination of the articles so as to re- 
sist putrefaction; and I suppose the only real thing of impor- 
tance in the matter, is to make the soup or gravy rich with the 
juice of the flesh: to boil well, and most securely exclude the air. 

It is an unquestionable fact, that at sea, as also in all country 
places, it is very often difficult to procure fresh meat and soups 
for the sick. This may readily be guarded against, by making 
and preserving what is called portable soup: and it may be made 



— 



480 

out of those parts of the animals, which are often thrown away, 
or lost for the want of a demand for them. 

The following are the directions for making it, taken from the 
Domestic Encyclopaedia: 

Boil one pound of gammon; one or two knuckles of veal; as 
many shins of beef, and three pounds of beef, in as much water 
as will cover them. Take the marrow out of the bones; and put 
in the spices and onions you wish to season with. Boil the 
whole under cover until the meat is done to rags: strain it off 
and put it into a cold place: when cold, take off the cake of fat, 
and put the soup into a pot, which should be in a, boiler; and 
boil the whole, frequently stirring it for several hours, until, 
when a little shall be taken out to cool, it shall be found pretty 
firm jelly. Then take it off and put it into small cups; and 
when it cools, take them out and expose them to the sun or in an 
oven to be dried. When dried, put them in tight tin canisters. 
When to be used, put it in hot water and let it dissolve; and 
add any other seasoning. 

The English of the whole is, make good jelly, or clean 
glue, and preserve them dry and from the air; and at all times, 
you may dissolve them, and make a pure, wholesome, fresh 
soup. 

Glanders. — It is known by an offensive discharge from the 
nose; and is said to be incurable. But I believe it might be 
cured, by injections of weak nitric acid, up the nose; keeping 
the horse from breathing at the time of squirting: or by mak- 
ing him snuff up much charcoal powder. The next remedy 
should be blisters kept discharging over his whole nose. 

Strangles, and Colts Distemfier. — The first is known by a swel- 
ling between the jaw bone and root of the tongue. The other 
is a swelling of the glands from the ears down underneath the 
throat. Bleed, purge, and poultice; if not dispersed by cold 
lead applications. 

It will be useless for me to add more on this subject, than 
the repetition of the remark: allow for size, and treat the dis- 
eases of horses as your own. 

The diseases of cattle, hogs, and sheep: it will also be use- 
less for me to dwell on; since I know nothing more than that 
they should be treated as those of horses. 



LBAp'OtS 



LIBRARY OF CONGRESS 



022 190 059 5 



